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

The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index.

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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Metadata

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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