Follow-up to Nonfatal Opioid Overdoses: More of the Same or an Opportunity for Change?
Authors: Jessica Gregg
Journal: Annals of Internal Medicine (2015)

Editorials5 January 2016Follow-up to Nonfatal Opioid Overdoses: More of the Same or an Opportunity for Change?Jessica Gregg, MD, PhDJessica Gregg, MD, PhDFrom Central City Concern, Portland, Oregon.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-2687 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail More than 90% of patients who survive a prescription opioid overdose continue to be prescribed opioids after the event, usually by the same prescriber. This is the astonishing finding of the study by Larochelle and colleagues (1) published in this issue. Using the Optum database of claims for a large national insurer, the authors found that among 2848 patients who survived an overdose on opioids prescribed for chronic noncancer pain, 91% continued to receive opioid prescriptions.Prescribing guidelines are clear that adverse events, such as overdose, are compelling reasons to withdraw prescription opioids (2). Therefore, it is tempting, and would ...References1. Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF. Opioid prescribing after nonfatal overdose and association with repeated overdose. A cohort study. Ann Intern Med. 2016;164:1-9. doi:10.7326/M15-0038 LinkGoogle Scholar2. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, et al; American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113-30. [PMID: 19187889] doi:10.1016/j.jpain.2008.10.008 CrossrefMedlineGoogle Scholar3. National Center on Addiction and Substance Abuse. Addiction medicine: closing the gap between science and practice. New York: Columbia University; 2012. Accessed at www.casacolumbia.org/addiction-research/reports/addiction-medicine on 1 August 2015. Google Scholar4. McLellan AT, Turner BJ. Chronic noncancer pain management and opioid overdose: time to change prescribing practices [Editorial]. Ann Intern Med. 2010;152:123-4. [PMID: 20083830]. doi:10.7326/0003-4819-152-2-201001190-00012 LinkGoogle Scholar5. Franklin GM; American Academy of Neurology. Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology. Neurology. 2014;83:1277-84. [PMID: 25267983] doi:10.1212/WNL.0000000000000839 CrossrefMedlineGoogle Scholar6. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers—United States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013;132:95-100. [PMID: 23410617] doi:10.1016/j.drugalcdep.2013.01.007 CrossrefMedlineGoogle Scholar7. Center for Integrated Health Solutions. Innovations in Addictions Treatment: Addiction Treatment Providers Working with Integrated Primary Care Services. Washington, DC: Substance Abuse and Mental Health Services Administration–Health Resources and Services Administration; 2013. Accessed at www.integration.samhsa.gov/clinical-practice/13_May_CIHS_Innovations.pdf on 10 August 2014. Google Scholar8. Liebschutz JM, Crooks D, Herman D, Anderson B, Tsui J, Meshesha LZ, et al. Buprenorphine treatment for hospitalized, opioid-dependent patients: a randomized clinical trial. JAMA Intern Med. 2014;174:1369-76. [PMID: 25090173] doi:10.1001/jamainternmed.2014.2556 CrossrefMedlineGoogle Scholar9. D'Onofrio G, O'Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313:1636-44. [PMID: 25919527] doi:10.1001/jama.2015.3474 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Central City Concern, Portland, Oregon.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2687.Corresponding Author: Jessica Gregg, MD, PhD, Central City Concern, 1535 North Williams Avenue, Portland, OR 97232; e-mail, jessica.[email protected]org.This article was published online first at www.annals.org on 29 December 2015. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOpioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose Marc R. Larochelle , Jane M. Liebschutz , Fang Zhang , Dennis Ross-Degnan , and J. Frank Wharam Follow-up to Nonfatal Opioid Overdoses Richard E. Moon and Jennifer V.F. Potter Follow-up to Nonfatal Opioid Overdoses Mitchel L. Galishoff Metrics Cited byPrescription Opioid Characteristics and Nonfatal Overdose Among Patients Discharged from Tennessee Emergency DepartmentsAcute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care UnitFollow-up to Nonfatal Opioid OverdosesRichard E. Moon, MD and Jennifer V.F. Potter, MDFollow-up to Nonfatal Opioid OverdosesMitchel L. Galishoff, MDDiscontinuing prescribed opioids reduces repeat overdoses 5 January 2016Volume 164, Issue 1Page: 62-63KeywordsBehaviorEndocarditisHeroinMedical educationMedical risk factorsOpioid addictionOpioidsPain managementPatientsSubstance abuse ePublished: 29 December 2015 Issue Published: 5 January 2016 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...