Jan. 19, 2010 -- Overdoses and drug-related deaths are not uncommon among
people taking opioid drugs that have been prescribed by a doctor for chronic
pain, a new government-funded study finds.
The finding suggests an urgent need to more closely monitor patients who are
prescribed drugs like OxyContin, Vicodin, and methadone for long-term use, as
well as the need to reassess current prescribing practices, an Obama
administration official noted.
“The threat to patient safety is too great to allow current pain management
and opioid prescribing practices to remain as they are,” White House Office of
National Drug Control Policy Deputy Director A. Thomas McLellan, PhD, writes in
an editorial published along with the study in the journal Annals of
Opioid drugs are increasingly prescribed long term for the treatment of
non-cancer-related pain such as back pain and degenerative arthritis.
Prescriptions for methadone alone have increased by more than 800% in the
United States in the last decade, and methadone-related deaths have risen more
According to the CDC, deaths from opioid use more than tripled in the U.S.
from 1999 to 2006, from 4,000 to 13,800.
It is widely believed that most opioid-related overdoses and deaths occur
among people who abuse the drugs, either by obtaining them without a
prescription or by "doctor shopping" to illegally get the drugs from multiple
Little research has been done to examine overdose risk among patients taking
medically prescribed opioids.
In an effort to better understand the rate of fatal and nonfatal overdoses
among patients taking prescribed opioids for chronic pain, researchers studied
nearly 10,000 such patients enrolled in a Seattle-based health cooperative.
All the patients had received three or more opioid prescriptions within a
period of 90 days for non-cancer pain between 1997 and 2005. The patients were
followed for an average of 42 months from their initial 90-day exposure.
During this time, there were 51 serious overdoses resulting in hospital
treatment or admission, including six deaths.
Patients treated with higher opioid doses (100 milligrams per day or more)
were nine times more likely to overdose than those treated with low doses
(maximum of 20 milligrams per day).
But most of the overdoses occurred in patients taking under 100 milligrams
per day because higher-dose prescriptions were not as common.
7 Nonfatal Overdoses for Every Drug Death
The analysis also found that:
Opioid overdoses occurred at similar rates across all age
The estimated annual overdose rates were 0.2%, 0.7%, and 1.8% among
patients receiving less than 20 milligrams a day, 50 to 99 milligrams a day,
and 100 or more milligrams a day, respectively, of opioids.
Suicide attempts and drug abuse were cited as contributing to overdose in
only a minority of cases.
More than seven nonfatal overdoses occurred for every fatal overdose among
the study participants.