title: Understanding opioid overdose characteristics involving prescription and illicit opioids: A mixed methods analysis.
abstract: Opioid abuse and misuse are significant public health issues. The CDC estimated 72% of pharmaceutical-related overdose deaths in the US in 2012 involved opioids. While studies of opioid overdoses have identified sociodemographic characteristics, agents used, administration routes, and medication sources associated with overdoses, we know less about the context and life circumstances of the people who experience these events.
  
  
  
  We analyzed interviews (n=87) with survivors of opioid overdoses or family members of decedents. Individuals experiencing overdoses were members of a large integrated health system. Using ICD codes for opioid overdoses and poisonings, we identified participants from five purposefully derived pools of health-plan members who had: 1) prescriptions for OxyContin(®) or single-ingredient sustained-release oxycodone, 2) oxycodone single-ingredient immediate release, 3) other long-acting opioids, 4) other short-acting opioids, or 5) no active opioid prescriptions.
  
  
  
  Individuals who experienced opioid overdoses abused and misused multiple medications/drugs; experienced dose-related miscommunications or medication-taking errors; had mental health and/or substance use conditions; reported chronic pain; or had unstable resources or family/social support. Many had combinations of these risks. Most events involved polysubstance use, often including benzodiazepines. Accidental overdoses were commonly the result of abuse or misuse, some in response to inadequately treated chronic pain or, less commonly, medication-related mistakes. Suicide attempts were frequently triggered by consecutive negative life events.
  
  
  
  To identify people at greater risk of opioid overdose, efforts should focus on screening for prescribed and illicit polysubstance use, impaired cognition, and changes in life circumstances, psychosocial risks/supports, and pain control.
authors: Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: bobbijo.h.yarborough@kpchr.org.
authors: Bobbi Jo H
authors: BJ
authors: Yarborough
authors: Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: scott.p.stumbo@kpchr.org.
authors: Scott P
authors: SP
authors: Stumbo
authors: Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: shannon.l.janoff@kpchr.org.
authors: Shannon L
authors: SL
authors: Janoff
authors: Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: micah.yarborough@kpchr.org.
authors: Micah T
authors: MT
authors: Yarborough
authors: Department of Public Health & Preventive Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Hill Road, CB 669, Portland, OR 97239, USA. Electronic address: mcartyd@ohsu.edu.
authors: Dennis
authors: D
authors: McCarty
authors: Purdue Pharma, L.P. One Stamford Forum, Stamford, CT 06901, USA. Electronic address: howard.chilcoat@pharma.com.
authors: Howard D
authors: HD
authors: Chilcoat
authors: Purdue Pharma, L.P. One Stamford Forum, Stamford, CT 06901, USA. Electronic address: paul.coplan@pharma.com.
authors: Paul M
authors: PM
authors: Coplan
authors: Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: carla.a.green@kpchr.org.
authors: Carla A
authors: CA
authors: Green
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000506:poisoning; D059350:Chronic Pain / Q000188:drug therapy / Q000523:psychology; D062787:Drug Overdose / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D010098:Oxycodone / Q000506:poisoning / Q000627:therapeutic use*; D059408:Pain Management / Q000523:psychology; D063487:Prescription Drug Misuse / Q000523:psychology*; D055656:Prescriptions / Q000706:statistics & numerical data*; D012307:Risk Factors; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D010098:Oxycodone
keywords: Intervention; Opioid analgesics; Overdose; Prevention; Risk