Touchpoints—opportunities to predict and prevent opioid overdose: a cohort study.
Open accessAbstract
Background Medical care, public health, and criminal justice systems encounters could serve as touchpoints to identify and intervene with individuals at high-risk of opioid overdose death. The relative risk of opioid overdose death and proportion of deaths that could be averted at such touchpoints are unknown.Methods We used 8 individually linked data sets from Massachusetts government agencies to perform a retrospective cohort study of Massachusetts residents ages 11 and older. For each month in 2014, we identified past 12-month exposure to 4 opioid prescription touchpoints (high dosage, benzodiazepine co-prescribing, multiple prescribers, or multiple pharmacies) and 4 critical encounter touchpoints (opioid detoxification, nonfatal opioid overdose, injection-related infection, and release from incarceration). The outcome was opioid overdose death. We calculated Standardized Mortality Ratios (SMRs) and Population Attributable Fractions (PAFs) associated with touchpoint exposure.Results The cohort consisted of 6,717,390 person-years of follow-up with 1315 opioid overdose deaths. We identified past 12-month exposure to any touchpoint in 2.7% of person-months and for 51.8% of opioid overdose deaths. Opioid overdose SMRs were 12.6 (95% CI: 11.1, 14.1) for opioid prescription and 68.4 (95% CI: 62.4, 74.5) for critical encounter touchpoints. Fatal opioid overdose PAFs were 0.19 (95% CI: 0.17, 0.21) for opioid prescription and 0.37 (95% CI: 0.34, 0.39) for critical encounter touchpoints.Conclusions Using public health data, we found eight candidate touchpoints were associated with increased risk of fatal opioid overdose, and collectively identified more than half of opioid overdose decedents. These touchpoints are potential targets for development of overdose prevention interventions.
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Hospitalizations are critical opportunities to engage patients at high risk for overdose to prevent future overdoses, as hospital addiction care with referral to treatment increases outpatient SUD treatment engagement.
“Hospitalizations are critical opportunities to engage patients who are at high risk for overdose to prevent future overdoses, as hospital addiction care with referral to treatment increases outpatient SUD treatment engagement.19,20”
From Assessment of Annual Cost of Substance Use Disorder in US Hospitals (2021) · cites this paper as [20]
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- Authors
- Larochelle, M. R., Bernstein, R., Bernson, D., Land, T., Stopka, T. J., Rose, A. J., Bharel, M., Liebschutz, J. M., & Walley, A. Y.
- Affiliations
- Boston University (US)
- Massachusetts Department of Public Health (US)
- University of Massachusetts Chan Medical School (US)
- Tufts University (US)
- RAND Corporation (US)
- University of Pittsburgh (US)
- Corresponding author
- Larochelle, Marc R.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 204
- Pages
- 107537
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC7020606
- OpenAlex
- W2971555090
- Cited by
- 189
- References
- 52
- Citations by year
- 2026: 20 · 2025: 21 · 2024: 36 · 2023: 25 · 2022: 23 · 2021: 47 · 2020: 16 · 2019: 1
- FWCI
- 20.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- School of Medicine, Boston University
- National Institute on Drug Abuse
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- opioid overdose, overdose prevention, touchpoints, opioid prescribing, multiple prescribers, opioid detoxification, injection-related infections, incarceration, drug overdose deaths, population attributable fraction, standardized mortality ratio
- MeSH terms
- Adolescent, Adult, Analgesics, Opioid, Child, Criminal Law, Female, Forecasting, Humans, Male, Massachusetts, Middle Aged, Opioid-Related Disorders, Patient Acceptance of Health Care, Drug Prescriptions, Retrospective Studies, Risk, Young Adult, Drug Overdose
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