Varying opioid dose increases risk for overdose

  • Glanz JM & al.
  • JAMA Netw Open
  • 5 Apr 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Misclassification bias and lost to follow-up.

Coauthored with Antara Ghosh, PhD