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Opioid-related death more common in adults with chronic pain

Mark Olfson

More than 60% of individuals who died of opioid-related causes had chronic pain diagnoses, according to recent findings.

“Much remains to be learned about the characteristics of people who die of opioid-related overdose. Characterizing common health care use patterns during the months preceding these fatalities might yield insights into clinical opportunities to identify high-risk patients,” Mark Olfson, MD, MPH, of Columbia University and the New York State Psychiatric Institute, and colleagues wrote. “A greater understanding of the health services used by individuals prior to opioid-related death may inform efforts to improve clinical identification of risk.”

To determine health service patterns before opioid-related death, researchers assessed clinical diagnoses, filled medication prescriptions and nonfatal poisoning events among individuals in the Medicaid program who died from opioid-related overdose. The study cohort included 13,089 opioid-related deaths.

More than 60% of the cohort had a clinical diagnosis of chronic noncancer pain conditions in the last year of life.

Participants with chronic pain diagnoses were significantly more likely to fill prescriptions for opioids (49% vs. 17.2%) and benzodiazepines (52.1% vs. 26.6%) during the last 30 days of life, compared with those without chronic pain diagnoses.

Diagnoses of opioid use disorder during this period were uncommon in both participants with and without chronic pain diagnoses (4.2% vs. 4.3%).

Clinical diagnoses of drug use (40.8% vs. 22.1%), depression (29.6% vs. 13%) or anxiety (25.8% vs. 8.4%) were more common among participants diagnosed with chronic pain, compared with the nonpain group.

“In the year prior to death, most individuals with opioid-related fatalities were diagnosed with chronic pain conditions, and many were diagnosed with psychiatric disorders and prescribed psychotropic medications,” the researchers wrote. “Although the claims histories suggest that clinical attention to substance use disorders was fairly common in the last year of life, few were diagnosed with opioid use disorder in the last 30 days of life. These service patterns highlight the need to improve the integration of specialized substance use services in pain treatment clinics and mental health centers.” – by Amanda Oldt

Disclosures: Olfson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.