A study published Monday in Annals of Internal Medicine revealed that almost all patients who experienced an overdose severe enough to send them to the emergency room received painkiller prescriptions afterwards. Study authors described the findings as “surprising and concerning”, given that those patients are at a higher risk of being admitted to the hospital for a second overdose.
“While this study wasn’t designed to answer why, one possibility is that providers are not aware that their patients experienced an overdose when making the decision to continue prescribing opioids,” lead author Dr. Marc R. Larochelle of Boston Medical Center told to Reuters.
In addition, he suggested that prescribers’ ignorance is a symptom of the U.S. fragmented health care system, since there is no communication between emergency departments and providers in the community.
Dr. Jessica Gregg of Central City Concern in Portland, Oregon, told Reuters by email that there are no communication mechanisms within health plans or through governmental organizations to inform opioid providers when a patient experiences an overdose. She explained that overdoses tend to occur when patients take too much of an opioid or when they combine them with other medications such as benzodiazepines or with alcohol.
For this study, researchers used a national commercial insurance claims database called Optum. They identified nearly 3,000 patients who suffered from a nonfatal overdose between 2000 and 2012 while taking long-term painkillers prescribed for chronic pain related to deceases other than cancer. After the overdose, 90 percent of these patients continued to get prescription drugs such as codeine, oxycodone, hydromorphone, hydrocodone and tramadol. More than 50 percent received the prescription from the same doctor who treated them before the overdose.
Researchers identified 212 second overdoses, 7 percent of the original group. Those patients whose prescriptions were still active two years after the first overdose were twice as likely to have experienced a second overdose than those whose prescriptions were discontinued.
Gregg commented that patients who have deliberately taken too much of an opioid are unlikely to report that misuse and their overdose to their prescriber out of fear that he will stop prescribing the drugs for them. Moreover, she pointed out that the majority of physicians, who receive little training, have few resources to treat chronic pain, which is why opioids become a frequent choice. Gregg also said that providers who are aware that their patients have experienced an overdose have two options: either they stop prescriptions knowing that the patients are likely to suffer from withdrawal or turn to illicit opioids for relief, or they continue the prescription even when the painkiller may cause more harm than good.
After a nonfatal overdose, Gregg recommends tapering off the medication gradually in order to prevent the patient from experiencing severe withdrawal symptoms. She affirmed that there is not enough evidence to prove that long-term opioids are convenient to treat chronic pain.