title: Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients.
abstract: OBJECTIVE
  Prescription opioid use and deaths related to serious toxicity, including overdose, have increased dramatically in the United States since 1999. However, factors associated with serious opioid-related respiratory or central nervous system (CNS) depression or overdose in medical users are not well characterized. The objective of this study was to examine the factors associated with serious toxicity in medical users of prescription opioids.
  
  
  METHODS
  Retrospective, nested, case-control analysis of Veterans Health Administration (VHA) medical, pharmacy, and health care resource utilization administrative data.
  
  
  METHODS
  Patients dispensed an opioid by VHA between October 1, 2010 and September 30, 2012 (N=8,987).
  
  
  METHODS
  Cases (N=817) experienced life-threatening opioid-related respiratory/CNS depression or overdose. Ten controls were randomly assigned to each case (N=8,170). Logistic regression was used to examine associations with the outcome.
  
  
  RESULTS
  The strongest associations were maximum prescribed daily morphine equivalent dose (MED)≥ 100 mg (odds ratio [OR]=4.1, 95% confidence interval [CI], 2.6-6.5), history of opioid dependence (OR=3.9, 95% CI, 2.6-5.8), and hospitalization during the 6 months before the serious toxicity or overdose event (OR=2.9, 95% CI, 2.3-3.6). Liver disease, extended-release or long-acting opioids, and daily MED of 20 mg or more were also significantly associated.
  
  
  CONCLUSIONS
  Substantial risk for serious opioid-related toxicity and overdose exists at even relatively low maximum prescribed daily MED, especially in patients already vulnerable due to underlying demographic factors, comorbid conditions, and concomitant use of CNS depressant medications or substances. Screening patients for risk, providing education, and coprescribing naloxone for those at elevated risk may be effective at reducing serious opioid-related respiratory/CNS depression and overdose in medical users of prescription opioids.
authors.affiliation: Venebio Group, Richmond, Virginia, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zedler
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Andrew
authors.initials: A
authors.lastname: Joyce
authors.forename: Catherine
authors.initials: C
authors.lastname: Vick
authors.forename: Furaha
authors.initials: F
authors.lastname: Kariburyo
authors.forename: Pradeep
authors.initials: P
authors.lastname: Rajan
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.forename: Lenn
authors.initials: L
authors.lastname: Murrelle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D016022:Case-Control Studies; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014728:Veterans; D058014:Veterans Health; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs
keywords: Opioid; Overdose; Predictors; Prescription; Risk; Toxicity