Predictors include history of overdose, higher opioid dose, three or more prescribers, any mental health diagnosis
By Elana Gotkine HealthDay Reporter
MONDAY, Oct. 23, 2023 (HealthDay News) — Ten predictors of opioid overdose have been identified, including history of overdose, higher opioid dose, three or more prescribers, and any mental health diagnosis, according to a systematic review published online Oct. 23 in CMAJ, the journal of the Canadian Medical Association.
Li Wang, Ph.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues conducted a systematic review of observational studies that examined predictors of opioid overdose after prescription for chronic pain. Data were included from 28 studies with 23,963,716 patients.
The researchers found that the studies reported the association of 103 predictors with fatal or nonfatal opioid overdose. Large relative associations were seen with history of overdose, higher opioid dose (per 90-mg increment), three or more prescribers, four or more dispensing pharmacies, prescription of fentanyl, current substance use disorder, any mental health diagnosis, depression, bipolar disorder, or pancreatitis based on moderate- to high-certainty evidence (odds ratios, 5.85, 2.57, 4.68, 4.92, 2.80, 2.62, 2.12, 2.22, 2.07, and 2.00, respectively). Among patients with the predictor, absolute risks varied from 2 to 6 and from 4 to 12 per 1,000 for fatal and nonfatal overdose, respectively.
“Awareness of these predictors may facilitate shared decision-making regarding prescribing opioids for chronic pain and may inform harm-reduction strategies,” the authors write.
One author received payment for expert testimony regarding analgesics, including opioids.
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