An analysis of the root causes for opioid-related overdose deaths in the United States
Abstract
OBJECTIVE: A panel of experts in pain medicine and public policy convened to examine root causes and risk factors for opioid-related poisoning deaths and to propose recommendations to reduce death rates. METHODS: Panelists reviewed results from a search of PubMed and state and federal government sources to assess frequency, demographics, and risk factors for opioid-related overdose deaths over the past decade. They also reviewed results from a Utah Department of Health study and a summary of malpractice lawsuits involving opioid-related deaths. RESULTS: National data demonstrate a pattern of increasing opioid-related overdose deaths beginning in the early 2000s. A high proportion of methadone-related deaths was noted. Although methadone represented less than 5% of opioid prescriptions dispensed, one third of opioid-related deaths nationwide implicated methadone. Root causes identified by the panel were physician error due to knowledge deficits, patient non-adherence to the prescribed medication regimen, unanticipated medical and mental health comorbidities, including substance use disorders, and payer policies that mandate methadone as first-line therapy. Other likely contributors to all opioid-related deaths were the presence of additional central nervous system-depressant drugs (e.g., alcohol, benzodiazepines, and antidepressants) and sleep-disordered breathing. CONCLUSIONS: Causes of opioid-related deaths are multifactorial, so solutions must address prescriber behaviors, patient contributory factors, nonmedical use patterns, and systemic failures. Clinical strategies to reduce opioid-related mortality should be empirically tested, should not reduce access to needed therapies, should address risk from methadone as well as other opioids, and should be incorporated into any risk evaluation and mitigation strategies enacted by regulators.
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Additional factors contributing to methadone related deaths are physician error due to knowledge deficits regarding evidence based guidelines used for pain treatment, unanticipated medical and mental health comorbidites, and insurance payer policies mandating methadone as first line therapy for pain.
“Additional factors contributing to methadone related deaths are physician error due to knowledge deficits regarding evidence based guidelines used for pain treatment, unanticipated medical and mental health comorbidites, and insurance payer policies mandating methadone as first line therapy for pain (Scanlon and Chugh, 2004; Webster et al., 2011).”
From National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. (2013) · cites this paper as Webster et al., 2011
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- Authors
- Webster, L. R., Cochella, S., Dasgupta, N., Fakata, K. L., Fine, P. G., Fishman, S. M., Grey, T., Johnson, E. M., Lee, L. K., Passik, S. D., Peppin, J., Porucznik, C. A., Ray, A., Schnoll, S. H., Stieg, R. L., & Wakeland, W.
- Affiliations
- University of Utah (US)
- University of North Carolina at Chapel Hill (US)
- University of California, Davis (US)
- Utah Department of Health (US)
- University of California, Los Angeles (US)
- Memorial Sloan Kettering Cancer Center (US)
- Bluegrass Care Navigators (US)
- Virginia Commonwealth University (US)
- Portland State University (US)
- Corresponding author
- Webster, Lynn R.
- Venue
- Pain Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-06
- Volume
- 12
- Issue
- suppl 2
- Pages
- S26-S35
- ISSN
- 1526-2375 (ISSN-L)
- 1526-4637
- OpenAlex
- W2140359307
- Cited by
- 295
- References
- 27
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 11 · 2023: 11 · 2022: 12 · 2021: 10 · 2020: 13 · 2019: 21 · 2018: 16 · 2017: 32 · 2016: 27 · 2015: 35 · 2014: 30 · 2013: 32 · 2012: 30
- FWCI
- 30.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pain Medicine (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 › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- opioid overdose deaths, methadone, root causes, risk factors, physician error, patient non-adherence, substance use disorders, central nervous system depressants, sleep-disordered breathing, prescriber behavior, risk evaluation and mitigation strategy, opioid prescribing policy, harm reduction
- MeSH terms
- Analgesics, Opioid, Humans, Medication Errors, Methadone, Pain, Patient Compliance, Sleep Apnea Syndromes, United States, Comorbidity, Databases, Factual, Substance-Related Disorders, Drug Overdose
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