There is a certain inalterability about trains. Their travel is predictable and linear. Slowing and stopping are extended affairs. It’s hard for a train to make a sharp turn.
Apparently, opiate prescribing is like that.
This study reviewed administrative data from a health insurer to identify patients receiving long-term opiate therapy. Patients were then included for analysis if they had a visit to an Emergency Department or a hospitalization related to heroin or opiate overdose. These same patients were then followed for up to 2 years following the index overdose, and their opiate prescribing tracked.
With a median follow-up of 299 days, opiates were dispensed to 91% of patients following opiate overdose – 7% of whom went to to repeated overdose, many of whom had multiple overdose events. Some patients had their opiate quantities curtailed, but the majority received the same – or even more – opiates after the overdose event.
Certainly, some of this prescribing is still appropriate – our tools for managing severe pain are grossly inadequate, and in hospice settings, inadvertent overdose is an acceptable hazard of control of malignant pain. But, just as certain, there is a cohort suffering the harms of shocking irresponsibility.
We’ve been getting bombarded with information regarding the harms of opiate prescribing for several years now; why are we still inflicting such great harm on the healthcare-seeking public?
“Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose”