Using Controlled Substance Receipt Patterns to Predict Prescription Overdose Death.

Area of Science:

• Public Health
• Epidemiology
• Pharmacology

Background:

• Controlled substance prescribing trends are evaluated using state-level data from prescription drug monitoring programs (PMP).
• The association between these prescribing trends and the risk of fatal prescription drug overdose is examined.

Purpose of the Study:

• To analyze PMP data to understand the link between prescription patterns and overdose mortality.
• To identify specific prescribing characteristics associated with increased risk of fatal drug overdose.

Main Methods:

• Retrospective analysis of Maine PMP records for individuals who died from prescription overdose (2006-2010).
• Matched cohort study comparing overdose decedents (n=690) with PMP users (n=34,500) based on age, gender, and residence.
• Evaluation of opioid dosage (MME/day) and timing of prescriptions relative to overdose death.

Main Results:

• Prescription opioids were implicated in 480 of 690 overdose deaths.
• A significant increase in overdose death risk was observed with daily milligram morphine equivalent (MME) dosages exceeding 100.
• Many overdose deaths involved co-ingestion of multiple substances.
• The majority of individuals prescribed MME >100/day received a prescription within 90 days of their overdose.

Conclusions:

• State PMP medication profiles are valuable for identifying prescription dosing patterns associated with drug overdose fatalities.
• High-dose opioid prescribing (MME >100/day) is a critical risk factor for prescription drug overdose death.