In the Journals

High opioid dosages increase overdose risk in young patients

Kao-Ping Chua, MD, PhD
Kao-Ping Chua

High daily opioid dosages are associated with a heightened risk for overdose in adolescents and young adults, according to results from a study published in JAMA Pediatrics.

“Clinicians may be able to mitigate the risk for overdose in adolescents and young adults by using the lowest effective dose, avoiding concurrent opioid and benzodiazepine prescribing and relying on short-acting opioids,” Kao-Ping Chua, MD, PhD, assistant professor in the department of pediatrics at the University of Michigan’s Susan B. Meister Child Health Evaluation and Research Center, told Healio. “Clinicians should carefully assess adolescents and young adults for mental health and substance use disorders before prescribing opioids. When these disorders are present, they should consider implementing heightened measures to prevent overdose, such as co-prescribing naloxone, the antidote to opioid overdose.”

Chua and colleagues conducted a retrospective cohort study of 2,752,612 privately insured patients aged 12 to 21 years with opioid prescription claims and no cancer diagnosis via the IBM MarketScan Commercial Claims and Encounters database between July 1, 2009, and Oct. 1, 2017. Treated opioid overdose was the outcome, researchers said.

Chua noted that on 3% of days on which patients were prescribed opioids, they were also taking prescribed benzodiazepine.

“That is not a high proportion, but it’s still striking because there are very few legitimate reasons for a young person to use opioids and benzodiazepines at the same time,” Chua said. “We need to understand which prescribers account for concurrent opioid and benzodiazepine use in adolescents and young adults and why this risky practice is happening.”

Among the 249 patients who overdosed, every increase in daily opioid dosage category was associated with a higher risk for overdose (OR = 1.18; 95% CI, 1.05-1.31). Concurrent benzodiazepine use (adjusted OR = 1.83; 95% CI, 1.24-2.71) and long-acting or extended-release opioid use (aOR = 2.01; 95% CI, 1.16-3.46) were associated with increased overdose risk compared with no use.

“No one wants to have their patient be in pain, and there is a perception that opioids are superior for pain even when this is not always the case,” Chua said. “For example, a randomized trial found that morphine was no better at controlling pain for children than ibuprofen. We need more studies to identify the situations in which non-opioids are safer and equally effective as opioids for pain.” – by Eamon Dreisbach

Disclosures: Chua reports receiving funding from career development award 1K08DA048110-01 from the National Institute on Drug Abuse. Please see the study for all other authors’ relevant financial disclosures.

Kao-Ping Chua, MD, PhD
Kao-Ping Chua

High daily opioid dosages are associated with a heightened risk for overdose in adolescents and young adults, according to results from a study published in JAMA Pediatrics.

“Clinicians may be able to mitigate the risk for overdose in adolescents and young adults by using the lowest effective dose, avoiding concurrent opioid and benzodiazepine prescribing and relying on short-acting opioids,” Kao-Ping Chua, MD, PhD, assistant professor in the department of pediatrics at the University of Michigan’s Susan B. Meister Child Health Evaluation and Research Center, told Healio. “Clinicians should carefully assess adolescents and young adults for mental health and substance use disorders before prescribing opioids. When these disorders are present, they should consider implementing heightened measures to prevent overdose, such as co-prescribing naloxone, the antidote to opioid overdose.”

Chua and colleagues conducted a retrospective cohort study of 2,752,612 privately insured patients aged 12 to 21 years with opioid prescription claims and no cancer diagnosis via the IBM MarketScan Commercial Claims and Encounters database between July 1, 2009, and Oct. 1, 2017. Treated opioid overdose was the outcome, researchers said.

Chua noted that on 3% of days on which patients were prescribed opioids, they were also taking prescribed benzodiazepine.

“That is not a high proportion, but it’s still striking because there are very few legitimate reasons for a young person to use opioids and benzodiazepines at the same time,” Chua said. “We need to understand which prescribers account for concurrent opioid and benzodiazepine use in adolescents and young adults and why this risky practice is happening.”

Among the 249 patients who overdosed, every increase in daily opioid dosage category was associated with a higher risk for overdose (OR = 1.18; 95% CI, 1.05-1.31). Concurrent benzodiazepine use (adjusted OR = 1.83; 95% CI, 1.24-2.71) and long-acting or extended-release opioid use (aOR = 2.01; 95% CI, 1.16-3.46) were associated with increased overdose risk compared with no use.

“No one wants to have their patient be in pain, and there is a perception that opioids are superior for pain even when this is not always the case,” Chua said. “For example, a randomized trial found that morphine was no better at controlling pain for children than ibuprofen. We need more studies to identify the situations in which non-opioids are safer and equally effective as opioids for pain.” – by Eamon Dreisbach

Disclosures: Chua reports receiving funding from career development award 1K08DA048110-01 from the National Institute on Drug Abuse. Please see the study for all other authors’ relevant financial disclosures.

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