title: Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans' Health Administration Patients.
abstract: OBJECTIVE
  Develop a risk index to estimate the likelihood of life-threatening respiratory depression or overdose among medical users of prescription opioids.
  A case-control analysis of administrative health care data from the Veterans' Health Administration identified 1,877,841 patients with a pharmacy record for an opioid prescription between October 1, 2010 and September 30, 2012. Overdose or serious opioid-induced respiratory depression (OSORD) occurred in 817. Ten controls were selected per case (n = 8,170). Items for an OSORD risk index (RIOSORD) were selected through logistic regression modeling, with point values assigned to each predictor. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution.
  
  
  RESULTS
  Fifteen variables most highly associated with OSORD were retained as items, including mental health disorders and pharmacotherapy; impaired drug metabolism or excretion; pulmonary disorders; specific opioid characteristics; and recent hospital visits. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 94% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model's C-statistic was 0.88 and Hosmer-Lemeshow goodness-of-fit statistic 10.8 (P > 0.05).
  
  
  CONCLUSIONS
  RIOSORD performed well in identifying medical users of prescription opioids within the Veterans' Health Administration at elevated risk of overdose or life-threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated.
authors.affiliation: Venebio Group, LLC, Richmond, Virginia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zedler
authors.affiliation: STATinMED Research, Ann Arbor, Michigan.
authors.forename: Lin
authors.initials: L
authors.lastname: Xie
authors.affiliation: STATinMED Research, Ann Arbor, Michigan.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Venebio Group, LLC, Richmond, Virginia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Joyce
authors.affiliation: Venebio Group, LLC, Richmond, Virginia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Vick
authors.affiliation: Venebio Group, LLC, Richmond, Virginia.
authors.forename: Janet
authors.initials: J
authors.lastname: Brigham
authors.affiliation: STATinMED Research, Ann Arbor, Michigan.
authors.forename: Furaha
authors.initials: F
authors.lastname: Kariburyo
authors.affiliation: STATinMED Research, Ann Arbor, Michigan.|Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.affiliation: Venebio Group, LLC, Richmond, Virginia.
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; D015897:Comorbidity; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D012120:Respiration Disorders / Q000139:chemically induced* / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Index; Opioid; Overdose; Questionnaire; Respiratory Depression; Risk