Prescription Opioid Dose Change Before Fatal Opioid-Detected Overdose

Area of Science:

• Public Health
• Epidemiology
• Pharmacology

Background:

• The United States faces an ongoing opioid overdose crisis.
• Understanding the role of prescribed opioids in overdose deaths is crucial.

Purpose of the Study:

• To investigate prescription opioid dispensing patterns in the 12 months preceding opioid-detected overdose deaths in Connecticut.
• To analyze demographic differences in these prescribing patterns.

Main Methods:

• Utilized multilevel modeling to assess changes in mean morphine equivalent (MME) daily dose over time.
• Examined linear and quadratic effects of time, age, sex, race, and ethnicity.
• Conducted sensitivity analyses excluding non-long-term opioid therapy recipients.

Main Results:

• Among 179 decedents with recent opioid prescriptions, a significant exponential increase in MME dose was observed in the 12 months before death.
• Linear increases in MME dose were significantly attenuated in men compared to women.
• Men were more likely to have nonprescription opioids detected in toxicology.

Conclusions:

• Rapid dose escalation of dispensed opioids may be associated with opioid-detected overdose fatalities.
• This association appears particularly significant among women.