@article{ref1,
title="Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study",
journal="Annals of internal medicine",
year="2016",
author="Larochelle, Marc R. and Liebschutz, Jane M. and Zhang, Fang and Ross-Degnan, Dennis and Wharam, J. Frank",
volume="164",
number="1",
pages="1-9",
abstract="BACKGROUND: Nonfatal opioid overdose is an opportunity to identify and treat substance use disorders, but treatment patterns after the overdose are unknown.<br><br>OBJECTIVE: To determine prescribed opioid dosage after an opioid overdose and its association with repeated overdose.<br><br>DESIGN: Retrospective cohort study.Setting: A large U.S. health insurer.Participants: 2848 commercially insured patients aged 18 to 64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between May 2000 and December 2012.Measurements: Nonfatal opioid overdose was identified using International Classification of Diseases, Ninth Revision, Clinical Modification, codes from emergency department or inpatient claims. The primary outcome was daily morphine-equivalent dosage (MED) of opioids dispensed from 60 days before to up to 730 days after the index overdose. We categorized dosages as large (≥100 mg MED), moderate (50 to <100 mg MED), low (<50 mg MED), or none (0 mg MED). Secondary outcomes included time to repeated overdose stratified by daily dosage as a time-varying covariate.<br><br>RESULTS: Over a median follow-up of 299 days, opioids were dispensed to 91% of patients after an overdose. Seven percent of patients (n = 212) had a repeated opioid overdose. At 2 years, the cumulative incidence of repeated overdose was 17% (95% CI, 14% to 20%) for patients receiving high dosages of opioids after the index overdose, 15% (CI, 10% to 21%) for those receiving moderate dosages, 9% (CI, 6% to 14%) for those receiving low dosages, and 8% (CI, 6% to 11%) for those receiving no opioids.Limitation: The cohort was limited to commercially insured adults.<br><br>CONCLUSION: Almost all patients continue to receive prescription opioids after an overdose. Opioid discontinuation after overdose is associated with lower risk for repeated overdose.Primary Funding Source: Health Resources and Services Administration.<p /> <p>Language: en</p>",
language="en",
issn="0003-4819",
doi="10.7326/M15-0038",
url="http://dx.doi.org/10.7326/M15-0038"
}