Title: Recommendations

Context:
In a prospective cohort study (not included in the evidence review as it did not include information on  acute versus chronic pain in the patient population), Dasgupta et al. (2015) compared residents of North  Carolina who had received an opioid prescription in the last year to residents who had not. The study examined the outcome of population-based rates of opioid overdose mortality by opioid dose, without use of a presupposed threshold (Table 3).[135] There was no safe dose of opioid. Among the over nine million individuals followed for one year, 629 died from opioid overdose. Of these 629 individuals, 151 had no record of having been dispensed an opioid. It is possible these opioids were obtained through illicit channels or social sharing/diversion. Of the 478 patients who died from an opioid overdose who were prescribed opioids, 235 (49%) had been prescribed <80 mg MEDD. Overdose incidence rate ratios (IRRs)  doubled each time the MEDD ranges increase from 60.0-79.9 mg to 80.0-99.9 mg (IRR 2.9 to 6.2), then to  120-139.9 mg (IRR 14.1), 160-179.9 mg (IRR 29.5), and 350-399.9 mg (IRR 63.2).

Question: Is there any study on the outcome of population-based rates of opioid overdose mortality by opioid dose, without the use of a presupposed threshold?

Answer: In a prospective cohort study (not included in the evidence review as it did not include information on  acute versus chronic pain in the patient population), Dasgupta et al. (2015) compared residents of North  Carolina who had received an opioid prescription in the last year to residents who had not.