Opioid dosing and risk of fatal overdose

January 01, 0001

Opioid dosing and risk of fatal overdose

Opioid use and deaths from opioid overdose have increased markedly in the United States. These US researchers the relationship between maximum prescribed daily opioid dose, and risk of death from opioid overdose. They looked specifically at patients with cancer, chronic pain, acute pain, and substance use disorders. They performed a case-control study using a sample of 154,684 patients at the Veteran’s Health Administration receiving opioids for pain, among whom there were 750 deaths by unintentional prescription opioid overdose.

The researchers found: "The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04%. The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication. The adjusted hazard ratios (HRs) associated with a maximum prescribed dose of 100 mg/d or more, compared with the dose category 1 mg/d to less than 20 mg/d, were as follows: among those with substance use disorders, adjusted HR = 4.54 (absolute risk difference approximation {ARDA} = 0.14%), among those with chronic pain, adjusted HR = 7.18 (ARDA = 0.25%), among those with acute pain, adjusted HR = 6.64 ( ARDA = 0.23%), and among those with cancer, adjusted HR = 11.99 (ARDA = 0.45%). Receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment."

The researchers concluded: "Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death."

The larger the dose of prescribed opioids, the higher the risk of accidental overdose, especially when treating cancer related pain.

For the full abstract, click here.

JAMA 305(13):1315-1321, 6 April 2011
© 2011 American Medical Association
Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths. Amy S. B. Bohnert, Marcia Valenstein, Matthew J. Bair, et al.

Category: A. General/Unspecified. Keywords: opioid, dosing, overdose, methadone, prescription, case-control study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 19 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.