title: Root cause analysis of prescription opioid overdoses.
abstract: Overdoses (ODs) of prescription opioids (RxOs) have become a major public health issue in the United States.
  
  
  OBJECTIVE
  To determine the root causes of accidental prescription opioid overdoses (RxO-OD).
  The authors conducted a root cause analysis using the Antecedent Target-Measurement method, interviewing three types of key informants: survivors of RxO-ODs, family members, and clinical experts.
  
  
  RESULTS
  Ten survivors, five family members, and three experts were interviewed. Proximal causes of RxO-ODs described by survivors and family members were recent RxO dose escalation (n = 9), polysubstance use (n = 5), and polypharmacy use (n = 3). Proximal causes were elicited by the following six antecedent causes: wanting to feel good/high (n = 9), perceived tolerance to RxO (n = 6), didn't know/believe it was dangerous (n = 5), wanting to reduce psychosocial pain (n = 5), wanting to reduce physical pain (n = 4), and wanting to avoid discomfort due to withdrawal symptoms (n = 4). RxOs involved in the OD were either prescribed by a doctor (n = 7), purchased from a dealer (n = 6), given/purchased from family/friends (n = 3), or stolen from family (n = 1). Psychosocial stressors (n = 9), chronic recurrent depression (n = 3), and chronic substance abuse/addiction (n = 4) were also distal and proximal causes of OD. Experts cited similar causes but added prescriberrelated causes (eg, inadequate training) and healthcare system and culture.
  
  
  CONCLUSIONS
  Patients at risk for OD can be identified and ODs potentially prevented. Opportunities for intervention include routine screening of patients using RxOs for psychosocial distress and coping, flagging of high-risk patients, care pathways for high-risk patients, clinician and patient training on OD prevention, and developing abuse-deterrent formulations of RxOs.
authors.affiliation: Analgesic Solutions, Natick, Massachusetts currently at Boston PainCare, Waltham, Massachusetts.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Wawrzyniak
authors.affiliation: Berkshire Medical Center, College of Human Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Alex
authors.initials: A
authors.lastname: Sabo
authors.affiliation: Berkshire Medical Center, College of Human Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Ann
authors.initials: A
authors.lastname: McDonald
authors.affiliation: Analgesic Solutions, Natick, Massachusetts.
authors.forename: Jeremiah J
authors.initials: JJ
authors.lastname: Trudeau
authors.affiliation: Berkshire Medical Center, College of Human Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Mon
authors.initials: M
authors.lastname: Poulose
authors.affiliation: Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, Arizona.
authors.forename: Mary
authors.initials: M
authors.lastname: Brown
authors.affiliation: Analgesic Solutions, Natick, Massachusetts.
authors.forename: Nathaniel P
authors.initials: NP
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016739:Behavior, Addictive; D062787:Drug Overdose / Q000453:epidemiology*; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D010146:Pain / Q000188:drug therapy*; D060891:Root Cause Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid