Patient characteristics associated with high-risk dose of prescription opioids

Background:The rate of prescription opioid-related deaths has increased considerably over the years. Of the 22,134 prescription-related deaths in US in 2010, 75% (16,451) were due to opioids. Studies have shown that among patients receiving prescription opioids, dosage is strongly associated with overdose mortality, particularly at doses greater than 100 morphine milligrams equivalent per day (MED). The objective of this study is to identify patient characteristics associated with high-risk doses (>100 MED) of prescription opioids in Los Angeles County (LAC).

Methods:California’s 2012 Controlled Substance Utilization Review and Evaluation System (CURES) data and drug information from Prescription Drug Monitoring Program Training and Technical Assistance Center were utilized to identify patient factors associated with high-risk doses of prescription opioids.

Results:Among 1,482,367 patients who received opioid prescriptions in LAC in 2012, 109,443 received at least one prescription with MED >100. Compared to patients >45 years old, patients <25 years old (OR=0.37, 95% CI: 0.36-0.38) and patients between the ages of 25-44 (OR=0.78, 95% CI: 0.77-0.79) were less likely to receive high-risk doses of prescription opioids. In addition, male (vs female, OR=1.34, 95% CI: 1.33-1.36), doctor shoppers (vs. non doctor shoppers, OR=5.86, 95% CI: 5.51-6.23), and multiple payment methods (vs. 1 method, OR=3.35, 95% CI: 3.29-3.42) were more likely to receive high-risk doses of prescription opioids.

Conclusions: Patient characteristics including age, gender, doctor shopper, and number of payment methods were associated with high-risk doses of prescription opioids. Understanding these risk factors can help clinicians make informed decisions to prevent prescription opioid-related deaths.