title: An analysis of the root causes for opioid-related overdose deaths in the United States.
abstract: OBJECTIVE
  A panel of experts in pain medicine and public policy convened to examine root causes and risk factors for opioid-related poisoning deaths and to propose recommendations to reduce death rates.
  
  
  METHODS
  Panelists reviewed results from a search of PubMed and state and federal government sources to assess frequency, demographics, and risk factors for opioid-related overdose deaths over the past decade. They also reviewed results from a Utah Department of Health study and a summary of malpractice lawsuits involving opioid-related deaths.
  
  
  RESULTS
  National data demonstrate a pattern of increasing opioid-related overdose deaths beginning in the early 2000s. A high proportion of methadone-related deaths was noted. Although methadone represented less than 5% of opioid prescriptions dispensed, one third of opioid-related deaths nationwide implicated methadone. Root causes identified by the panel were physician error due to knowledge deficits, patient non-adherence to the prescribed medication regimen, unanticipated medical and mental health comorbidities, including substance use disorders, and payer policies that mandate methadone as first-line therapy. Other likely contributors to all opioid-related deaths were the presence of additional central nervous system-depressant drugs (e.g., alcohol, benzodiazepines, and antidepressants) and sleep-disordered breathing.
  
  
  CONCLUSIONS
  Causes of opioid-related deaths are multifactorial, so solutions must address prescriber behaviors, patient contributory factors, nonmedical use patterns, and systemic failures. Clinical strategies to reduce opioid-related mortality should be empirically tested, should not reduce access to needed therapies, should address risk from methadone as well as other opioids, and should be incorporated into any risk evaluation and mitigation strategies enacted by regulators.
authors.affiliation: Lifetree Clinical Research, Salt Lake City, Utah, USA. lrwebstermd@gmail.com
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Webster
authors.forename: Susan
authors.initials: S
authors.lastname: Cochella
authors.forename: Nabarun
authors.initials: N
authors.lastname: Dasgupta
authors.forename: Keri L
authors.initials: KL
authors.lastname: Fakata
authors.forename: Perry G
authors.initials: PG
authors.lastname: Fine
authors.forename: Scott M
authors.initials: SM
authors.lastname: Fishman
authors.forename: Todd
authors.initials: T
authors.lastname: Grey
authors.forename: Erin M
authors.initials: EM
authors.lastname: Johnson
authors.forename: Lewis K
authors.initials: LK
authors.lastname: Lee
authors.forename: Steven D
authors.initials: SD
authors.lastname: Passik
authors.forename: John
authors.initials: J
authors.lastname: Peppin
authors.forename: Christina A
authors.initials: CA
authors.lastname: Porucznik
authors.forename: Albert
authors.initials: A
authors.lastname: Ray
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Schnoll
authors.forename: Richard L
authors.initials: RL
authors.lastname: Stieg
authors.forename: Wayne
authors.initials: W
authors.lastname: Wakeland
mesh_terms: D000701:Analgesics, Opioid / Q000506:poisoning* / Q000627:therapeutic use; D015897:Comorbidity; D016208:Databases, Factual; D062787:Drug Overdose / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008508:Medication Errors; D008691:Methadone / Q000506:poisoning; D010146:Pain / Q000188:drug therapy; D010349:Patient Compliance; D012891:Sleep Apnea Syndromes / Q000150:complications; D019966:Substance-Related Disorders / Q000150:complications; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone