- High variability in opioid dose more than tripled the risk for overdose among long-term opioid users, even among patients receiving low doses, whereas sustained opioid discontinuation cuts the risk for overdose by around half.
Why this matters
- Recent guidelines have encouraged clinicians to reduce patients’ reliance on long-term opioid therapy, but these findings suggest that varying dosage may not be the best approach.
- Nested case-control study of 228 patients who experienced an opioid overdose and 3547 matched control patients who did not.
- Funding: National Institute on Drug Abuse.
- Mean opioid doses before the index date were 110.6 mg morphine equivalents for case patients and 73.0 mg morphine equivalents for control patients.
- Patients exposed to the highest category of dose variability (SD>27.2 mg of morphine equivalents) had a significantly greater risk for overdose (matched OR, 3.32; 95% CI, 1.63-6.77) vs those exposed to the low-dose variability (SD≤5.3 mg of morphine equivalents).
- Sustained opioid therapy discontinuation (in 3 months before the index date) was associated with a lower risk for overdose (matched OR, 0.49; 95% CI, 0.26-0.93) vs no discontinuations.
- Misclassification bias and lost to follow-up.
Coauthored with Antara Ghosh, PhD