Touchpoints - Opportunities to predict and prevent opioid overdose: A cohort study

Area of Science:

• Public Health
• Epidemiology
• Data Science

Background:

• Medical care, public health, and criminal justice encounters can identify individuals at high risk of fatal opioid overdose.
• The specific risks and potential for intervention at these touchpoints remain largely unknown.

Purpose of the Study:

• To determine the relative risk of opioid overdose death associated with specific prescription and encounter touchpoints.
• To quantify the proportion of opioid overdose deaths that could be averted by intervening at these identified touchpoints.

Main Methods:

• A retrospective cohort study using linked data from Massachusetts government agencies.
• Analysis of 6,717,390 person-years for residents aged 11+, identifying 1315 opioid overdose deaths.
• Calculation of Standardized Mortality Ratios (SMRs) and Population Attributable Fractions (PAFs) for opioid prescription and critical encounter touchpoints.

Main Results:

• Exposure to any touchpoint in the past 12 months was identified in 2.7% of person-months but accounted for 51.8% of opioid overdose deaths.
• Critical encounter touchpoints showed a significantly higher SMR (68.4) compared to opioid prescription touchpoints (12.6).
• Fatal opioid overdose Population Attributable Fractions were 0.19 for prescription touchpoints and 0.37 for critical encounter touchpoints.

Conclusions:

• Eight candidate touchpoints, including opioid prescriptions and critical encounters, are associated with increased risk of fatal opioid overdose.
• These touchpoints collectively identify over half of all opioid overdose decedents.
• The identified touchpoints represent promising targets for developing effective overdose prevention interventions.