title: Opioid prescriptions for chronic pain and overdose: a cohort study.
abstract: BACKGROUND
  Long-term opioid therapy for chronic noncancer pain is becoming increasingly common in community practice. Concomitant with this change in practice, rates of fatal opioid overdose have increased. The extent to which overdose risks are elevated among patients receiving medically prescribed long-term opioid therapy is unknown.
  
  
  OBJECTIVE
  To estimate rates of opioid overdose and their association with an average prescribed daily opioid dose among patients receiving medically prescribed, long-term opioid therapy.
  
  
  METHODS
  Cox proportional hazards models were used to estimate overdose risk as a function of average daily opioid dose (morphine equivalents) received at the time of overdose.
  
  
  METHODS
  HMO.
  
  
  METHODS
  9940 persons who received 3 or more opioid prescriptions within 90 days for chronic noncancer pain between 1997 and 2005.
  
  
  METHODS
  Average daily opioid dose over the previous 90 days from automated pharmacy data. Primary outcomes--nonfatal and fatal overdoses--were identified through diagnostic codes from inpatient and outpatient care and death certificates and were confirmed by medical record review.
  
  
  RESULTS
  51 opioid-related overdoses were identified, including 6 deaths. Compared with patients receiving 1 to 20 mg/d of opioids (0.2% annual overdose rate), patients receiving 50 to 99 mg/d had a 3.7-fold increase in overdose risk (95% CI, 1.5 to 9.5) and a 0.7% annual overdose rate. Patients receiving 100 mg/d or more had an 8.9-fold increase in overdose risk (CI, 4.0 to 19.7) and a 1.8% annual overdose rate.
  
  
  CONCLUSIONS
  Increased overdose risk among patients receiving higher dose regimens may be due to confounding by patient differences and by use of opioids in ways not intended by prescribing physicians. The small number of overdoses in the study cohort is also a limitation.
  
  
  CONCLUSIONS
  Patients receiving higher doses of prescribed opioids are at increased risk for overdose, which underscores the need for close supervision of these patients.
  
  
  BACKGROUND
  National Institute of Drug Abuse.
authors.affiliation: Group Health Research Institute, Seattle, Washington 98101, USA.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Dunn
authors.forename: Kathleen W
authors.initials: KW
authors.lastname: Saunders
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Banta-Green
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Constance M
authors.initials: CM
authors.lastname: Weisner
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Silverberg
authors.forename: Cynthia I
authors.initials: CI
authors.lastname: Campbell
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000506:poisoning*; D002908:Chronic Disease; D015331:Cohort Studies; D004334:Drug Administration Schedule; D062787:Drug Overdose / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid