Overdoses from opioid painkillers occur frequently in people who are taking relatively small doses of pain medication, according to a new study that has some experts calling for more restrictions on opioid prescribing.
Researchers at the University of Washington School of Public Health analyzed Medicaid data on opioid overdoses in Washington State between 2006 and 2010 – and found that many non-fatal overdoses didn’t fit the usual profile of a long term opioid user taking high doses of pain medication.
Less than half of those patients were “chronic users” who had been prescribed opioids for more than 90 days. And only 17% percent of the overdoses involved patients taking a high morphine-equivalent dose of over 120 mg per day — what is considered a “yellow flag” in Washington State for possible opioid abuse.
Surprisingly, nearly three out of ten (28%) patients who overdosed were taking a relatively low opioid dose of just 50 mg per day. Sedatives were involved in nearly half of the overdoses.
In 2007, Washington State adopted some of the toughest regulations in the country on opioid prescribing — guidelines that the researchers believe should be even more restrictive…
Based on the recommendations of this and other studies, Washington State’s Interagency Guideline on Prescribing Opioids for Pain was recently revised to caution doctors about prescribing opioids at any dose. The new guidelines extend to the treatment of acute pain, not just chronic pain. Physicians are also advised not to prescribe opioids unless their patients showed “clinically meaningful improvement” in physical function, in addition to pain relief…
More recent data suggest that the “epidemic” of painkiller abuse is abating. Hydrocodone prescriptions fell by 8% last year and it is no longer the most widely prescribed medication in the U.S. A recent report by a large national health insurer found that total opioid dispensing declined by 19% from 2010 to 2012 and the overdose rate dropped by 20 percent.
According to the National Institutes of Health, only about 5% of patients taking opioids as directed for a year end up with an addiction problem.