title: Risk Factors of Prescription Opioid Overdose Among Colorado Medicaid Beneficiaries.
abstract: This study aims to determine risk factors of opioid overdose among the Colorado Medicaid population. A retrospective nested case-control study was undertaken. Medicaid beneficiaries who had ≥1 medical claim for an emergency department visit or a hospitalization associated with an opioid overdose from July 2009 to June 2014 were defined as cases. Controls were selected using a nearest neighbor matching without replacement. The matched controls were selected on the basis of age, sex, and opioid prescription. One case was matched with three controls. Multivariate conditional logistic regression was used to compare risk factors. A total of 816 cases with 2,448 controls were included. Six factors were associated with opioid overdose: mean morphine dose equivalent (>50 mg/d; odds ratio [OR] = 1.986 [95% confidence interval [CI], 1.509-2.614]), methadone use (switching opioid to methadone vs. no methadone use; OR = 7.230 [95% CI, 2.346-22.286]), drug/alcohol abuse (OR = 3.104 [95% CI, 2.195-4.388]), other psychiatric illness (OR = 1.730 [95% CI, 1.307-2.291]), benzodiazepine use (OR = 2.005 [95% CI, 1.516-2.652]), and the number of pharmacies used by the beneficiary (≥4 pharmacies vs. 1 pharmacy; OR = 1.514 [95% CI, 1.003-2.286]). In conclusion, several factors are associated with opioid overdose. States and communities should ensure the availability of at-home intranasal naloxone for overdose rescue on the basis of the presence of risk factors.
  
  
  CONCLUSIONS
  This article presents the risk factors of opioid overdose among the Colorado Medicaid population. On the basis of study findings, Colorado Medicaid is currently working with physicians, hospitals, and other health system stakeholders to continue to develop policies to identify and assist this subset of our population. One such policy will be to provide at-home intranasal naloxone for overdose rescue.
authors.affiliation: Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. Electronic address: piyamethd@gmail.com.
authors.forename: Piyameth
authors.initials: P
authors.lastname: Dilokthornsakul
authors.affiliation: Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Gina
authors.initials: G
authors.lastname: Moore
authors.affiliation: Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Campbell
authors.affiliation: Department of Health Care Policy and Financing, State of Colorado, Denver, Colorado.
authors.forename: Robert
authors.initials: R
authors.lastname: Lodge
authors.affiliation: Department of Health Care Policy and Financing, State of Colorado, Denver, Colorado.
authors.forename: Cathy
authors.initials: C
authors.lastname: Traugott
authors.affiliation: Department of Health Care Policy and Financing, State of Colorado, Denver, Colorado.
authors.forename: Judy
authors.initials: J
authors.lastname: Zerzan
authors.affiliation: Peak Statistical Services, Evergreen, Colorado.
authors.forename: Richard
authors.initials: R
authors.lastname: Allen
authors.affiliation: Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Page
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D059350:Chronic Pain / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D003120:Colorado / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000209:etiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Medicaid; Risk factor; chronic pain; opioid; opioid overdose