1. Characteristics of Premature Death in PCHC Patients Receiving Prescription Opioids
Jessica E. Bates, Pharm.D.
PGY-1 Pharmacy Resident
Penobscot Community Health Care

2. Objective
Be able to identify the characteristics of patients using opioids that increase the likelihood of premature death

3. Background Every morning, 40 of them don’t wake up.
Every night about 8 million Americans fall asleep after taking a prescription opioid.
Every morning, 40 of them don’t wake up.
In 2013, at least 16,235 patients overdosed on prescription opioid drugs.
About 80% of these were unintentional.
Every year more patients overdose on prescription opioid drugs than heroin, cocaine, or all other illicit drugs combined.

4. Purpose
Determine whether there are characteristics in patients who were receiving opioids at the time of death, which may be associated with an increase in the risk of premature death
An inter-disciplinary team, established in 2013, reviews patient cases with the intention of limiting the amount of inappropriate prescribing of opioid medications

5. Methods
Retrospective chart review of non-terminally ill patients receiving opioid prescriptions, deceased before the age of 60 between January 1, and December 31, 2015
Primary outcome: report demographic and other characteristics that demonstrated an association between opioid use and risk of premature death

6. Results 32 patients included
Average age at death: 48 years (range 25-59)
3% (1 patient) was on more than one opioid
Hydrocodone/APAP was the most common opioid prescribed before death
Of 11 patients with dose reported at time of death, the average MED was (range 0-960)

7. No history of hallucinogenic, opioid, or stimulant abuse
Results
No history of hallucinogenic, opioid, or stimulant abuse

8. Results
Other comorbidities reported in at least 1 patient include bipolar disorder, personality disorder, Downs Syndrome, dementia, asthma, sleep apnea

9. Results

10. Results

11. Discussion
The 2015 data demonstrates the following associations between opioid use and premature death:
Nicotine, alcohol, and cannabis abuse
Comorbid psychiatric disorders (PTSD, anxiety, and depression), COPD, and obesity
Heart failure, cardiac arrest, and/or respiratory failure constitute the most common causes of death

12. The Next Steps
The over-arching study will be performed to determine what the benefit is of having an inter- disciplinary Controlled Substance Initiative team review cases of patients receiving chronic opioid prescriptions
Focus on patients with the characteristics described in this sub-study

13. References
Manchikanti L, Helm S, Fellows B, et al. Opioid epidemic in the United States. Pain Physician 2012;15(3 suppl):es9-38.
National Center for Health Statistics. NCHS data on drug poisoning deaths. June Accessed August 7, 2015.
CARESAlliance: Improving the Safety of Opioid Therapy. Talking to Patients About Opioid Analgesics, A Pharmacist’s Resource. Hazelwood, MO: Coviden, Accessed August 7, 2015.
Centers for Disease Control and Prevention. Specific drugs involved in drug poisoning deaths, Accessed August 7, 2015.
Juman, R. Why long-term use of opioids is not the answer. MedPageToday Accessed August 7, 2015.
Ullrich, P. Narcotic drugs for the treatment of chronic pain: A double-edged sword. Spine-Health Accessed August 7, 2015.

14. Knowledge Check
Each year in the United States, more patients overdose on which of the following than any other drug:
Heroin
Prescription opiate drugs
Cocaine
Bath salts