Nine in 10 people who overdose on prescription opioids continue to receive prescriptions after the overdose, according to a new study published by Annals of Internal Medicine.
Researchers used commercial insurance claims database Optum to track nearly 3,000 patients who had experienced a nonfatal opioid overdose between May 2000 and December 2012. They found within a median of 299 days after the overdose, most patients were again dispensed opioids and 7 percent had a repeated opioid overdose. Within two years, the cumulative incidence of repeated overdose jumped to 17 percent for those receiving high dosages of opioids after the initial overdose.
While it is easy to attribute continued prescription after an overdose to poor care and sloppy prescribing, the issue is much more complex, according to Jessica Gregg, MD, PhD, who wrote a corresponding editorial on the topic.
"For instance, it is likely that many of the prescribers in the study did not know about their patients' overdoses," Dr. Gregg wrote. "As noted by the authors, there are currently no widespread systems in place, either within health plans or through governmental organizations, for notifying providers when overdoses occur. Until such systems exist, providers will be left to act with dangerously limited knowledge."
Dr. Gregg asserts that physicians do not have enough training, resources or support to fully address chronic pain or addiction, and especially do not when the conditions overlap. Building on state-based prescription monitoring programs and providing prescribers with sufficient knowledge and support are needed to improve the results found in the study, she writes, which will require changes in medical education, chronic disease management models and team-based approaches to care.
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