Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths

Bohnert, Amy S. B.

doi:10.1001/jama.2011.370

Cited by 1,509Opioid Use Disorder TreatmentPain Management and Opioid UsePharmaceutical Practices and Patient Outcomes

Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths

Bohnert, Amy S. B.·2011·JAMA

DOI 10.1001/jama.2011.370

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Abstract

CONTEXT: The rate of prescription opioid-related overdose death increased substantially in the United States over the past decade. Patterns of opioid prescribing may be related to risk of overdose mortality. OBJECTIVE: To examine the association of maximum prescribed daily opioid dose and dosing schedule ("as needed," regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders. DESIGN: Case-cohort study. SETTING: Veterans Health Administration (VHA), 2004 through 2008. PARTICIPANTS: All unintentional prescription opioid overdose decedents (n = 750) and a random sample of patients (n = 154,684) among those individuals who used medical services in 2004 or 2005 and received opioid therapy for pain. Main Outcome Measure Associations of opioid regimens (dose and schedule) with death by unintentional prescription opioid overdose in subgroups defined by clinical diagnoses, adjusting for age group, sex, race, ethnicity, and comorbid conditions. RESULTS: The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04%.The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication. The adjusted hazard ratios (HRs) associated with a maximum prescribed dose of 100 mg/d or more, compared with the dose category 1 mg/d to less than 20 mg/d, were as follows: among those with substance use disorders, adjusted HR = 4.54 (95% confidence interval [CI], 2.46-8.37; absolute risk difference approximation [ARDA] = 0.14%); among those with chronic pain, adjusted HR = 7.18 (95% CI, 4.85-10.65; ARDA = 0.25%); among those with acute pain, adjusted HR = 6.64 (95% CI, 3.31-13.31; ARDA = 0.23%); and among those with cancer, adjusted HR = 11.99 (95% CI, 4.42-32.56; ARDA = 0.45%). Receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment. CONCLUSION: Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.

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Over reliance on prescription opioids as a frontline treatment for chronic pain contributed to a national epidemic including increased rates of opioid addiction, accidental overdose, and mortality.
“Over reliance on the use of prescription opioids as a frontline treatment for chronic pain contributed to a national epidemic including increased rates of opioid addiction, accidental overdose, and even mortality [16–20].”
From Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program (2024) · cites this paper as [16]

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Authors: Bohnert, A. S. B.
Affiliations: University of Michigan (US)
Corresponding author: Bohnert, Amy S. B.
ORCID: Bohnert, Amy S. B.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2011-04-06
Volume: 305
Issue: 13
Pages: 1315
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2011.370
OpenAlex: W2070123858
Cited by: 1,509
References: 26
Citations by year: 2026: 24 · 2025: 46 · 2024: 82 · 2023: 67 · 2022: 94 · 2021: 150 · 2020: 141 · 2019: 170 · 2018: 139 · 2017: 138 · 2016: 109 · 2015: 100 · 2014: 84 · 2013: 69 · 2012: 65
FWCI: 77.70
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: prescription opioid overdose, opioid prescribing patterns, as-needed dosing, opioid overdose deaths, cancer pain, chronic pain, acute pain, substance use disorders, veterans, opioid analgesics, overdose risk factors, Veterans Health Administration, veterans' health care utilization
MeSH terms: Acute Disease, Adolescent, Adult, Aged, Analgesics, Opioid, Chronic Disease, Female, Humans, Male, Middle Aged, Pain, Practice Patterns, Physicians', Drug Prescriptions, Risk, United States, Veterans, Cohort Studies, Case-Control Studies, Young Adult, Drug Overdose

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Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths

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