Boston - A study led by Boston Medical Center (BMC) indicates that most patients with chronic pain who are hospitalized after a nonfatal opioid overdose continue to receive prescription opioids after the overdose and are at high risk for experiencing a repeated overdose. The findings, published online ahead of print in the Annals of Internal Medicine, highlight the challenges faced by physicians to balance the known risks with potential benefits of prescription opioids for patients with chronic pain and reinforces the importance of developing tools that will help better identify and treat patients at risk for opioid use disorders and/or overdose.
According to Marc LaRochelle, MD, MPH, a physician in general internal medicine at BMC who led the research team, this study is the first to examine treatment patterns and risk of repeated overdose following a nonfatal opioid overdose.
Utilizing Optum, a large national commercial insurance claims database with data on 50 million individuals over a 12 year period, the researchers identified nearly 3,000 individuals who were prescribed opioids for chronic pain that had been treated in the emergency department and/or as an inpatient following a nonfatal opioid overdose. The data showed 91 percent of patients continued to be prescribed opioids after the nonfatal overdose. In addition, 70 percent received prescriptions from the same provider who prescribed them opioids before their initial overdose. And, at two years of follow-up, patients who continued taking high dosages of opioids were twice as likely to have another overdose compared to those who discontinued opioid use after their initial overdose.
"While the nonfatal opioid overdoses in this study were treated and recorded in a patient's medical record, it is unclear if the physician who prescribed the medication was notified when their patient experienced an overdose event, which is important to note," said LaRochelle, who also is an assistant professor of medicine at Boston University School of Medicine. "This could be the result of patients not receiving emergency care where they receive outpatient care as different health systems utilize different electronic medical records -- and many times, these event records never make it to the outpatient provider. As a provider, this is troublesome because this is information that I need access to in order to best treat my patient."
Several ways to potentially improve notification of treated nonfatal overdose would be provide a seamless communication stream between emergency and/or hospital providers and outpatient providers. Prescription drug monitoring programs are available in 49 states that could be leveraged to help improve communication. Additionally, because patients' health insurance records include hospitalizations and prescriptions, there could be a way to implement prior authorizations for patients after an overdose before they are able to obtain another opioid prescription.
"The intent of this study is not to point fingers but rather use the results to motivate physicians, policy makers and researchers to improve how we identify and treat patients at risk of opioid-related harms before they occur," said LaRochelle.
This study was funded in part by the Health Resources and Services Administration under notice of grant award numbers T32 HP10251 and T32 HP12706; the Ryoichi Sasakawa Fellowship Fund; and the Harvard Pilgrim Health Care Institute.
About Boston Medical Center
Boston Medical Center is a private, not-for-profit, 496-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $119 million in sponsored research funding in fiscal year 2015. It is the 11th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. It does business in Massachusetts as BMC HealthNet Plan and as Well Sense Health Plan in New Hampshire, serving more than 315,000 people, collectively. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet -- 13 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.