Thursday, December 31, 2015

The Opiate Overdose Train

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”
http://annals.org/article.aspx?articleid=2479117

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