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Opioid overdose deaths continue to rise, particularly from illicit opioids. Prescribing patterns alone may not identify high-risk individuals, necessitating tailored interventions for diverse opioid overdose epidemics.

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Area of Science:

  • Public Health
  • Epidemiology
  • Pharmacology

Background:

  • Opioid prescribing has declined since 2010, yet overdose deaths persist.
  • Illicit opioid involvement in overdose fatalities is increasing.
  • Understanding prescribing patterns is crucial for overdose prevention.

Purpose of the Study:

  • To examine opioid prescribing patterns in the year preceding fatal overdoses.
  • To differentiate patterns between prescription and illicit opioid-involved deaths.
  • To inform targeted overdose reduction strategies.

Main Methods:

  • Retrospective cohort study of 1,893 Illinois residents who died from opioid overdose in 2016.
  • Linked decedent data with Prescription Monitoring Program records.
  • Calculated weekly morphine milligram equivalents for 52 weeks pre-overdose.

Main Results:

  • 309 deaths involved prescription opioids; 1,461 involved illicit opioids.
  • Illicit opioid overdose rates were higher among Black residents (23/100,000) vs. White residents (10.5/100,000).
  • Prescription opioid decedents filled significantly more prescriptions in the last year and week of life compared to illicit opioid decedents.

Conclusions:

  • Prescribing patterns alone are insufficient to identify all at-risk individuals, especially illicit opioid users.
  • Interventions must consider distinct prescribing patterns linked to different overdose types.
  • Strategies should be localized to address specific epidemic characteristics.