Study: Patients Who Overdose on Opioids Still Receive Prescriptions

A total of 91 percent of people who overdosed on opioid medications were able to refill prescriptions for the painkillers, according to a January 2016 study published in the Annals of Internal Medicine.

“Almost all patients continue to receive prescription opioids after an overdose,” the authors concluded, even though “opioid discontinuation after overdose is associated with lower risk for repeated overdose.”

Opioids are prescription drugs that doctors prescribe to treat pain. Drugs like oxycodone (OxyContin) and hydrocodone (Vicodin, Lortab) are extremely effective at relieving pain, but they are also highly addictive and frequently abused.

The authors examined 2,848 adults who survived opioid overdoses between May 2000 and December 2012. During that time, opioids contributed to a sharp increase in deaths from drug overdoses, according to the Centers for Disease Control and Prevention. The 16,651 deaths attributed to opioids in 2010 spurred the researchers to begin the study.

The researchers looked at serious overdoses — those causing emergency room visits or hospital stays — in a national insurance database. They found 70 percent of patients who received opioid prescriptions after an overdose received the drugs from the same doctor.

“This is an astonishing finding,” wrote Dr. Jessica Gregg of the Oregon School of Medicine in an accompanying editorial. “Prescribing guidelines are clear that adverse events, such as overdose, are compelling reasons to withdraw prescription opioids.”

The findings were more alarming considering 41 percent of patients who overdosed had a documented problem with drug abuse. The researchers were also unable to tell if the prescribing doctors were aware of the past overdose when writing prescriptions.

Patterns of Opioid Use After Overdose

The authors of the study investigated how long it took patients to receive a prescription refill after an overdose, if the dosage they took changed and whether or not they suffered a second overdose.

They examined patients ages 18 – 64 years old, with an average age of 44, taking opioids like oxycodone, hydrocodone, morphine, codeine and fentanyl for long-term treatment of noncancerous pain. The majority of patients, 46 percent, were taking doses larger than those considered to be moderate or low.

In the 30 days after an overdose, about one-third of individuals studied obtained prescriptions for large daily doses. After 60 days, 70 percent had obtained an opioid prescription. A total of 91 percent of patients eventually received a prescription.

Prescription dosages didn’t tend to change after an overdose, and if they did they usually decreased. However, seven percent of patients examined suffered a second overdose in the time frame of the study.

The researchers concluded that within two years of the study:

9 percent
of patients on “low” doses likely suffered another overdose.
15 percent
of patients on “moderate” doses likely suffered another overdose.
17 percent
of patients on “high” doses likely suffered another overdose.

Cutting patients off from opioids after an overdose isn’t simple, especially when it’s unclear if doctors are always aware of a patient’s previous overdose when writing prescriptions.

Prescribing Opioids a Difficult Dilemma for Doctors

Even with knowledge of a past overdose, doctors are in a tough predicament when deciding when to prescribe opioids.

“It is tempting, and would be easy, to attribute (the study’s) results to poor care, bad decisions, or sloppy prescribing,” Gregg wrote. “However, the problem goes well beyond individual prescribers’ practices.”

A number of factors could have played into the doctors’ decisions to write prescriptions, Gregg wrote, including:

  • Doctors may not have known an overdose occurred.
  • Physicians may have been inadequately trained to address chronic pain or prescription drug addiction.
  • Doctors may have been reluctant to decrease medication that patients believed they needed to function.
  • Doctors may have feared patients would turn to illicit drugs, like heroin, if they refused to write a prescription.

“(Pain management) is a difficult area,” Dr. Wanda Filer, president of the American Academy of Family Physicians, told NPR in December. “It’s a skill set that we all work to master.”

Help is on the way for doctors, though. A total of 49 states have developed prescription-monitoring programs that hospitals can use to inform a patient’s doctors about an overdose, according to the Los Angeles Times.

The CDC is also developing guidelines to help primary care physicians determine when prescribing opioids is appropriate. The organization is accepting public comments during the first weeks of January.

“I think the guidelines will be very important once they’ve gone through their public comment period,” Filer said. “Many of us have not had a chance to really dig into them yet, but I like the idea that the CDC is bringing a credibility factor to this.”

With painkiller sales and the number of people dying from drug overdoses reaching record numbers in recent years, doctors need all of the help they can get.