Top risk factors for opioid use disorder, overdose

Prescription opioids are contributing to an epidemic of opioid addiction and overdose in the U.S., and a variety of factors are contributing to the problem.  

Jones

That’s according to Christopher M. Jones, PharmD, MPH, director of the division of science policy at HHS. Jones presented the session, “Treating Opioid Use Disorder and Reversing Opioid Overdose,” at the Academy of Managed Care Pharmacy (AMCP) Nexus 2016 in National Harbor, Maryland, on October 4.

In 2014, nearly 2 million Americans met the diagnostic criteria for a past-year prescription opioid use disorder, and at least 14,000 people died from a prescription opioid overdose, said Jones. “We continue to see year-over-year increases in opioid deaths related to opioids.”

He added that there is a significant correlation between opioid abuse and heroin use. “I found about 75% of people who used heroin in the past year reported nonmedical use of prescription opioids prior to initiating heroin,” he said of research he conducted.

And the correlation goes both ways, said Jones. Another study found that people who abuse prescription opioid painkillers are 40 times more likely to have heroin abuse or dependence.  

What’s driving the problem?

The increase in prescription opioid prescribing practices, which began in the late 1990s, corresponds with the increase in prescription opioid deaths, said Jones, noting that peak opioid prescribing occurred in 2012.

A few critical concerns when it comes to opioid prescribing include:

· Higher rates of prescribing in certain states. Jones noted that on the state level, there are significant variations in opioid prescribing. Those states with higher prescribing rates also tend to have higher death rates. This indicates that actions need to be taken at the state level to address prescribing practices, said Jones.

· Higher rates of prescribing in certain specialties. In addition, certain specialties account for a higher rate of opioid prescribing per patient, such as pain medicine, surgery, and dental, he said.

· Higher rates of prescribing by certain providers. About 10% to 20% of prescribers prescribe 60% to 80% of opioid prescriptions, said Jones. Managed care pharmacy data, he said, can help identify where excessive prescribing is happening to identify where interventions need to occur.

Perhaps more troubling, while most primary care physicians say they have “substantial concerns” about prescription opioid abuse in communities, they also say they have low confidence in their ability to prescribe opioids well, according to one study.

Yet, many of them continue to prescribe them, said Jones.

In addition, between 2002 and 2014, there was a 41% increase in patients who received benzodiazepines with an opioid prescription, and about 50% of those came from the same physician on the same day, according to one study.

“That’s pretty inconsistent with most guideline recommendations,” said Jones. 

Patients at highest risk for prescription opioid overdose

According to Jones, the patients at highest risk for prescription opioid overdose include:

· Patients who receive high daily doses of opioids.

· Patients who obtain opioids from multiple prescribers or pharmacies.

· Medicaid patients and those living in rural areas.

· Patients with chronic pain, substance abuse disorders, mental health problems, and/or prior nonmedical use.

Men also have higher rates of opioid use disorder, as do patients between ages 35 to 54 years, whites, and American Indians/Alaska natives, said Jones.

Opioid use disorder is a “pressing public health issue,” he said. “We have to ensure that the policies we have in place are addressing these issues.”

To read about three changes that Jones said are helping combat opioid abuse or misuse, read “Four developments helping address the opioid epidemic."