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A History of Being Prescribed Controlled Substances and Risk of Drug Overdose Death

Authors


  • Author Contributions

  • Dr. Paulozzi had full access to all of the data in the study and takes responsibility for its integrity and for the accuracy of its analysis.

  • Study concept and design: Paulozzi, Kilbourne, Desai, Shah, Landen

  • Acquisition of data: Paulozzi, Shah, Nolte, Harvey, Loring

  • Analysis and interpretation of data: Paulozzi, Kilbourne, Desai, Shah, Landen

  • Drafting of the manuscript: Paulozzi

  • Critical revision of the manuscript for important intellectual content: Paulozzi, Kilbourne, Shah, Landen, Nolte, Harvey, Loring

  • Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

  • Presented: National Harold Rogers Prescription Drug Monitoring Program Meeting, Washington, DC, June 29, 2010.

  • Financial Disclosures: Authors have no financial interests in this manuscript. All funding for this study came from the Centers for Disease Control and Prevention and the New Mexico Department of Health.

Leonard J Paulozzi, MD, MPH, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 601 Sunland Park Drive, Suite 200, El Paso, TX 79912, USA. Tel: 770-365-7616; Fax: 915-834-5973. E-mail: lbp4@cdc.gov.

Abstract

Objective.  The abuse of prescription drugs has increased dramatically since 1990. Persons who overdose on such drugs frequently consume large doses and visit multiple providers. The risk of fatal overdose for different patterns of use of opioid analgesics and sedative/hypnotics has not been fully quantified.

Design.  Matched case-control study. Cases were 300 persons who died of unintentional drug overdoses in New Mexico during 2006–2008, and controls were 5,993 patients identified through the state prescription monitoring program with matching 6-month exposure periods.

Outcome Measures.  Death from drug overdose or death from opioid overdose. Exposures were demographic variables and characteristics of prescription history. Crude and adjusted odds ratios (AOR) were calculated.

Results.  Increased risk was associated with male sex (AOR 2.4, 95% confidence interval [CI] 1.8–3.1), one or more sedative/hypnotic prescriptions (AOR 3.0, CI 2.2–4.2), greater age (AOR 1.3, CI 1.2–1.4 for each 10-year increment), number of prescriptions (AOR 1.1, CI 1.1–1.1 for each additional prescription), and a prescription for buprenorphine (AOR 9.5, CI 3.0–30.0), fentanyl (AOR 3.5, CI 1.7–7.0), hydromorphone (AOR 3.3, CI 1.4–7.5), methadone (AOR 4.9, CI 2.5–9.6), or oxycodone (AOR 1.9, CI 1.4–2.6). Patients receiving a daily average of >40 morphine milligram equivalents had an OR of 12.2 (CI 9.2–16.0).

Conclusions.  Patients being prescribed opioid analgesics frequently or at high dosage face a substantial overdose risk. Prescription monitoring programs might be the best way for prescribers to know their patients' prescription histories and accurately assess overdose risk.

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