Drug overdose death rates in the United States have risen steadily since 1970 and recent data from the Centers for Disease Control and Prevention suggests that the increase is largely related to prescription opioid painkillers. The statistics show that by 2006 abuse of opioid painkillers, such as oxycodone and hydrocodone, were involved in more overdose deaths than heroin and cocaine combined.
New research (subscription required) published today in the Journal of the American Medical Association shows that patients prescribed higher doses of pain medication are at an increased risk of dying from an overdose. According to a Health Day story:
For this study the researchers examined VA data on 750 accidental opioid overdose deaths that occurred from 2004 to 2008 and a random sample of almost 155,000 patients who received opioids to treat pain in 2004 or 2005.
The overdose rate among patients treated with opioids was 0.04 percent. Patients who died of an opioid overdose were much more likely to be middle-aged and white; more likely to have chronic or acute pain, more likely to have substance use disorders or other psychiatric diagnoses; and less likely to have cancer.
Patients who received a higher maximum daily dose (100 milligrams/day or more) were more likely to overdose than those who received a lower maximum daily dose (between 1 and 20 mg/day).
Researchers made the following recommendations to help prevent abuse of painkillers:
- Ascertain patient history of substance use and dependence
Use treatment contracts
- Use treatment contracts
- Schedule frequent follow-up visits that include a urine toxicological screen for patients at special risk.
- Increase use of specialty pain care may reduce the burden on primary care clinicians for these frequent follow-up visits.