A recently published study concludes that the risk of accidental overdose from prescription opioids is closely tied to the dosage level prescribed, and that the threshold for safe prescribing may be lower than most current guidelines specify. The findings are based on a close examination of the medical and prescription records of some 450 veterans with chronic pain, half of whom died from accidental opioid overdose, and half who did not overdose. On average, the cohort who overdosed had been prescribed a dosage that was 71% higher than those who did not. The study was led by Amy Bohnert, MHS, PhD, an epidemiologist with the University of Michigan Medical School and VA Ann Arbor Healthcare System, and appears online in the journal Medical Care.
Current guidelines for opioid prescribing recommend a maximum daily dose of 100 morphine-equivalent milligrams (MEM); however, the study found that the average prescribed dose in the overdose cohort was 98 MEM versus 48 MEM among those who did not. Dr. Bohnert was a member of the Core Expert Group created by the CDC to develop new prescribing guidelines for opioids. “Our findings suggest that changing clinical practices to avoid escalating doses for patients with chronic pain could make a major difference in the number of patients who die,” she commented. Draft guidelines released by the Core Group recommend that providers consider other painkillers first, prescribe the lowest effective dosage, put additional precautions in place for any patient to whom they prescribe more than 50 MEM a day, and avoid prescriptions over 90 MEM a day for chronic pain patients. Read more about the study findings here. The article abstract may be read here.