An accompanying editorial says doctors are not irresponsible; they lack access to information about patients'prior overdoses.
One would think that after a person survives an overdose on prescription pain killers, the first step would be making sure the doctor who wrote the prescription is warned not to write another.
According to a new study published in the Annals of Internal Medicine, apparently that’s the last thing that happens.
The study led by Marc R. Larochelle, MD, MPH, based on a look back at claims from a major US health insurer, examined records of 50 million patients filed between 2000 and 2012 and identified 2848 patients between 18 and 64 who received opioids for pain other than cancer pain and survived an overdose. They honed in on the window of 2 months before the incident and 2 months after it occurred.
Larochelle and his team found that 91% of those who survived an opioid overdoes not only got another prescription within the next 9 months, but that 17% suffered a repeat overdose within the next 2 years. The authors reported that 70 percent of the overdose survivors got their prescriptions from the same physician.
Are the doctors who wrote new prescriptions irresponsible? In most cases, no. An accompanying editorial suggests that in many cases the physicians may be unaware of the overdoses, but the data point to clues. Dose levels typically increased in the weeks leading up to the overdose and in some cases fell afterward, which should signal an event even if the prescribing physician is not expressly told what occurred.
Most doctors may realize that cutting patients who are in pain off from medication may sent them hunting for illicit drugs, such as heroin, so managing patients who are suffering requires training and support. The authors say better communication, both between doctors and patients but also across the healthcare system is essential.
Patients who have suffered an overdose may not volunteer the information to a prescribing physician. Those who do not yet have access to an electronic health record may only find out the information accidentally unless they are trained to pick up certain clues, such as a drop off in a patient’s request for an increased dose.
The author of the editorial said that’s not what’s happening right now. “Most providers receive little training, have few resources, and receive minimal support to address either chronic pain or addiction,” wrote Jessica Gregg, MD, PhD, in describing a system that is almost set up to invite errors.
Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam F. Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study. Ann Intern Med. 2015; doi:10.7326/M15-0038.