Opioid prescribing patterns examined in related research letter, study

March 03, 2014

Bottom Line: Most people who use opioid painkillers without a physician's prescription initially get them from friends or relatives for free, but as the number of days of use increase sources for the medications expand to include prescriptions from physicians and purchases from friends, relatives, drug dealers or strangers.

Author: Christopher M. Jones, Pharm.D., M.P.H., who was with the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, at the time of research but is now with the U.S. Food and Drug Administration, and colleagues.

Background: Little research has examined whether the source of opioid medication differs by the frequency of nonmedical use.

How the Study Was Conducted: The authors used data from the National Survey on Drug Use and Health (in which people were asked about the frequency of nonmedical use, the type of opioid pain reliever used and the source of the opioid used most recently) to examine the sources of opioid pain relievers for nonmedical use and compare them with the frequency of use by individuals.

Results: Of the estimated annual 12 million nonmedical users, most were men. Most nonmedical users obtained the medication for free from friends and relatives. However the source of the pain relievers varied based on frequency of use. As days of use increased, opioid medications were obtained from other sources, including prescriptions from physicians and buying the medication from friends, relatives, drug dealers or strangers. Opioid pain relievers used non-medically were most frequently prescribed by a physician for users who reported 200 to 365 days of use.

Discussion: "These results underscore the need for interventions targeting prescribing behaviors, in addition to those targeting medication sharing, selling and diversion. The essential steps health care providers can take to curb this serious health problem include more judicious prescribing, use of prescription drug-monitoring programs and screening patients for abuse risk before prescribing opioids."

(JAMA Intern Med. Published online March 3, 2014. doi:10.1001/jamainternmed.2013.12809. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Bottom Line: High-risk use of prescription opioid pain relievers is common and increasing in Tennessee, and it is associated with an increased risk of death from overdose. Each year about 2 million Tennesseans (one-third of the state population) fill an opioid prescription.

Author: Jane A. Gwira Baumblatt, M.D., of the Agency for Healthcare Research and Quality, Rockville, Md., and colleagues.

Background: In Tennessee, drug overdose deaths increased from 422 in 2001 to 1,062 in 2011, and opioid-related deaths increased from 118 to 564 during the same period. The Tennessee Controlled Substances Monitoring Program (TNCSMP) monitors the prescribing of controlled substances.

How the Study Was Conducted: The authors analyzed opioid prescription data from the TNCSMP from 2007 through 2011 to identify risk factors associated with opioid-related overdose deaths. They defined high-risk use as patients who used four or more prescribers or pharmacies per year to get medications and a high-risk dosage as a daily average of more than 100 morphine milligram equivalents (MMEs).

Results: Opioid prescription rates increased from 108.3 to 142.5 per 100 individuals per year from 2007 through 2011. Hydrocodone and oxycodone were the most commonly prescribed opioids. Physicians wrote most of the prescriptions, followed by advanced practice nurses, dentists, physician assistants and osteopathic physicians. Among all the patients prescribed opioids in 2011, 7.6 percent used more than four prescribers, 2.5 percent used more than four pharmacies and 2.8 percent had an average daily dosage greater than 100 MMEs. An increased risk of opioid-related overdose death was associated with using four or more prescribers, four or more pharmacies and more than 100 MMEs. Patients with one or more of these risk factors accounted for 55 percent of all overdose deaths.

Discussion: "These findings highlight the need for interventions using a multifaceted approach that targets patients, prescribers and pharmacies to reduce mortality associated with opioid use. However, these interventions will need development and evaluation to determine their effectiveness."

(JAMA Intern Med. Published online March 3, 2014. doi:10.1001/jamainternmed.2013.12711. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

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