Prescription Opioid Dose Change Before Fatal Opioid-Detected Overdose

The opioid overdose crisis continues within the United States, and the role of prescribed opioids and prescribing patterns in overdose deaths remains an important area of research. This study investigated patterns of prescription opioids dispensed in the 12 months before opioid-detected overdose death in Connecticut between May 8, 2016, and January 2, 2018, considering differences by demographic characteristics.

The sample included decedents who had an opioid dispensed within 30 days preceding death. Using multilevel modeling, we estimated the slope of change in mean morphine equivalent (MME) daily dose over 12 months before death, considering linear and quadratic effects of time. We also estimated the main effects of age, sex, race, and ethnicity and their interactions with time on MME. A sensitivity analysis examined how excluding decedents who did not receive long-term (≥90 days) opioid therapy affected mean MME slopes. The secondary analysis explored differences according to toxicology results.

Among 1,580 opioid-detected deaths, 179 decedents had prescribed opioids dispensed within 30 days preceding death. Decedents' mean age was 47.3 years (SD = 11.5), 65.5% were male, 81% were White non-Hispanic, 9.5% were Black non-Hispanic, and 9.5% were Hispanic. In the time-only model, linear (beta = 6.25, p < .01) and quadratic (beta = 0.49, p = .02) effects of time were positive, indicating exponentially increasing dose before death. Linear change in MME was significantly attenuated in men compared with women (beta = -4.87, p = .03); however, men were more likely to have nonprescription opioids in their toxicology results (p = .02). Sensitivity analysis results supported the primary findings.

Rapid dose increases in dispensed opioids may be associated with opioid-detected overdose deaths, especially among women.