Prescription Opioid Characteristics and Nonfatal Overdose Among Patients Discharged from Tennessee Emergency Departments

被引:2
作者
Krishnaswami, Shanthi [1 ]
Mukhopadhyay, Sutapa [1 ]
Markus, Shannon A. [2 ]
Nechuta, Sarah J. [3 ]
机构
[1] Tennessee Dept Hlth, Off Informat & Analyt, Andrew Johnson Tower,7th Floor, Nashville, TN 37243 USA
[2] Vanderbilt Univ, Med Ctr, Dept Emergency Med, Nashville, TN USA
[3] Grand Valley State Univ, Dept Publ Hlth, Grand Rapids, MI USA
关键词
emergency department; nonfatal opioid overdose; prescription opioid dose; hospital discharge data; prescription drug monitoring data; UNITED-STATES; PRESCRIBING PATTERNS; DRUG OVERDOSE; CHRONIC PAIN; ASSOCIATION; DEATHS; RISK; HISTORY;
D O I
10.1016/j.jemermed.2021.07.050
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background : Despite increasing trends of nonfatal opioid overdoses in emergency departments (EDs), population-based studies comparing prescription opioid dosing patterns before and after nonfatal opioid overdoses are limited. Objectives : To evaluate characteristics of prescribing behaviors before and after nonfatal overdoses, with a focus on opioid dosage. Methods : Included were 5,395 adult residents of Tennessee discharged from hospital EDs after a first nonfatal opioid overdose (2016-2017). Patients were linked to eligible prescription records in the Tennessee Controlled Substance Monitoring Database. We estimated odds ratios (OR) and 95% confidence intervals (CI) to evaluate characteristics associated with filling opioid prescriptions 90 days before overdose and with high daily dose (>= 90 morphine milligram equivalents) 90 days after overdose. Results : Among patients who filled a prescription both before and after an overdose, the percentage filling a low, medium, and high dose was 33.7%, 31.9%, and 34.4%, respectively, after an opioid overdose (n = 1,516). Most high-dose users before an overdose (> 70%) remained high-dose users with the same prescriber after the overdose. Male gender, ages >= 35 years, and medium metro residence were associated with increased odds of high-dose filling after an opioid overdose. Patients filling overlapping opioid-benzodiazepine prescriptions and with > 7 days' supply had increased odds of filling high dose after an opioid overdose (OR 1.4, 95% CI 1.08-1.70 and OR 3.7, 95% CI 2.28-5.84, respectively). Conclusions: In Tennessee, many patients treated in the ED for an overdose are still prescribed high-dose opioid analgesics after an overdose, highlighting a missed opportunity for intervention and coordination of care between ED and non-ED providers. (C) 2021 Elsevier Inc. All rights reserved.
引用
收藏
页码:51 / 63
页数:13
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