The Prescription Opioid Overdose Epidemic

Introduction: The Rise of Prescription Opioid Use

Over the last two decades, prescription opioid-related overdose has emerged as a major public health threat in the United States. Overdose deaths involving prescription opioids have quadrupled since 1999 [1,2] and parallel the striking increase of U.S. sales and consumption of prescription opioids (e.g., hydrocodone, oxycodone, methadone) [3]. From 1999 to 2015, more than 183,000 people have died in the U.S. from overdoses related to prescription opioids [1,2].

  • Today, nearly half of all U.S. opioid overdose deaths involve a prescription opioid [1].
  • In 2015, more than 15,000 people died from overdoses involving prescription opioids [4].
  • Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids [5].

Figure 1: Prescription opioid-related deaths (2002-2015) (NIH NIDA Overdose Death Rates)

Opioid-Induced Respiratory Depression (OIRD): Understanding the Risk Factors

Opioid-related overdoses involve life-threatening respiratory depression resulting from profound depression of the central nervous system.  These events can occur unintentionally in patients using opioids for approved therapeutic indications (“medical users”) and even at dosages in the recommended prescribing range. In fact, approximately 80% of fatal overdoses are considered unintentional [6].

More than half of overdoses occur in patients who are prescribed a relatively high morphine equivalent dose (MED) of >100 mg/day [7].  However, life-threatening OIRD can occur in patients prescribed opioids with daily MED within recommended levels under conditions that enhance their respiratory and central nervous system depressant effects or result in opioid accumulation or prolonged duration of action [8-11]. Certain co-existing health conditions (e.g., impaired liver or kidney function, pulmonary disease) or concurrent use of other medications or substances (e.g., sedatives or alcohol) can exceed a patient’s ability to safely tolerate opioid exposure and can result in life-threatening OIRD.  Excessive and/or inappropriate opioid prescribing is associated with increased emergency department visits for overdose or serious OIRD and subsequent hospitalization [12-16].

The economic burden of the opioid overdose epidemic associated with prescription opioids exceeds a staggering $75 billion annually [17] with workplace costs due to lost productivity and replacement wages equaling direct healthcare costs [17,18].

Fighting the Epidemic: Venebio Opioid Advisor

In response to the public health threat posed by the opioid overdose epidemic, Venebio Group developed the Venebio Opioid Advisor clinical decision support tool to support safer opioid prescribing. The tool integrates multiple influences and complex interactions involved in the use of opioids for their multidimensional primary indications — pain and opioid use disorder. Use of VOA can substantially reduce the risk of life-threatening overdose at the point-of-care with individual patients and at a population health level.

 


References

  1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. http://wonder.cdc.gov.
  2. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. ePub: 16 December 2016.
  3. Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999–2012. NCHS data brief, no 189. Hyattsville, MD: National Center for Health Statistics. 2015.
  4. CDC Prescription Opioid Overdose Data (https://www.cdc.gov/drugoverdose/data/overdose.html)
  5. Substance Abuse and Mental Health Services Administration. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings on drug-related emergency department visits. The DAWN Report. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2013.  http://www.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm
  6. CDC, Wide-ranging OnLine Data for Epidemiologic Research (WONDER), 2014.
  7. Centers for Disease Control Prevention, Vital signs: risk for overdose from methadone used for pain relief – United States, 1999-2010.MMWR Morb Mortal Wkly Rep, 2012. 61(26): p. 493-7. 22763888.
  8. Bohnert, A.S., M. Valenstein, M.J. Bair, D. Ganoczy, J.F. McCarthy, M.A. Ilgen, and F.C. Blow, Association between opioid prescribing patterns and opioid overdose-related deaths.JAMA, 2011. 305(13): p. 1315-21.
  9. Zedler, B., L. Xie, L. Wang, A. Joyce, C. Vick, F. Kariburyo, P. Rajan, O. Baser, and L. Murrelle, Risk factors for serious prescription opioid-related toxicity or overdose among Veterans Health Administration patients.Pain Med, 2014. 15(11): p. 1911-29.
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  11. Gomes, T., D.N. Juurlink, I.A. Dhalla, A. Mailis-Gagnon, J.M. Paterson, and M.M. Mamdani, Trends in opioid use and dosing among socio-economically disadvantaged patients.Open Med, 2011. 5(1): p. e13-22. PMID 3205807.
  12. Kolodny, A., C.S. Courtwright Dt Fau – Hwang, P. Hwang Cs Fau – Kreiner, J.L. Kreiner P Fau – Eadie, T.W. Eadie Jl Fau – Clark, G.C. Clark Tw Fau – Alexander, and G.C. Alexander, The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction.(1545-2093 (Electronic)).
  13. Centers for Disease Control Prevention, Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008.MMWR Morb Mortal Wkly Rep, 2011. 60(43): p. 1487-92.
  14. Albert, M., L. McCaig, and S. Uddin, Emergency department visits for drug poisoning: United States, 2008-2011.NCHS Data Brief, 2015(196): p. 1-8.
  15. Coben, J.H., S.M. Davis, P.M. Furbee, R.D. Sikora, R.D. Tillotson, and R.M. Bossarte, Hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers.Am J Prev Med, 2010. 38(5): p. 517-24.
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  18. Rice, J.B., Kirson, N.Y., Shei, A., Cummings, A.K.G., Bodnar, K., Birnbaum, H.G., Ben-Joseph, R. Estimating the Costs of Opioid Abuse and Dependence from an Employer Perspective: A Retrospective Analysis Using Administrative Claims Data. Appl Health Econ Health Policy. 2014;12:435-446.