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.
Jane A. Gwira Baumblatt, M.D., of the Agency for Healthcare Research and Quality, Rockville, Md., and colleagues.
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).
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.
“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.”
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