1. Background Results Methods Conclusions
Overdose Risk in Patients Newly Prescribed Opioids Compared to Those with Continued Use Sophia Sheikh MD, Morgan Henson MPH, Ashley Booth-Norse MD, Caroline Dodd BSH, Carmen Smotherman MS, Eric Edgerton MD, Colleen Kalynych EdD, Phyllis Hendry MD
Background
The Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) is a validated tool that calculates a risk class (highest risk class is 7) for a patient’s probability of experiencing an opioid overdose (OD) within the next six months.
Our objective was to compare opioid OD risk, OD predictive factors, and sociodemographics between patients newly prescribed opioids to those with continued opioid use.
Table 1. Frequency of Predictive Factors
Results
Of the total 67 visits in which a prescription opioid was issued, 40 (60%) were for patients in Group 1.
The average risk class for both groups was 3 (Group 1, median 3; Group 2, median 4), translating to a 6.8% average predicted probability of OD in the next 6 months.
There was no significant difference in the number of predictive factors between groups, with Group 1 having more predictive factors (total 47, median=1) than Group 2 (total 41, median=2) (p= 0.169).
The most common predictive factors for OD was use of antidepressants [Group 1 (13, 33%), Group 2 (14, 54%)], hx of COPD [Group 1 (6, 15%), Group 2 (8, 30%)], and use of a benzodiazepine [Group 1 (6, 15%), Group 2 (5, 19%)].
Ethnicity significantly differed between the two groups (p <0.001). Most patients in Group 1 were African American (32, 80%) and in Group 2 were Caucasian (17, 63%).
There was no difference in age or gender.
Risk Predictors
Frequency
Group 1
Group 2
Substance Abuse Disorder 6 1
Bipolar or Schizophrenia 4
Stroke or other cerebrovascular disease 3 2
Kidney disease with clinically significant renal impairment
Heat failure
Nonmalignant pancreatic disease
Chronic pulmonary disease 8
Recurrent headache
Prescription benzodiazepine 5
Prescription antidepressant 13 14
Methods
This study is a secondary descriptive analysis of data collected from a prospective observational study of patients ≥ 18 years of age returning to the ED within 30 days of an index visit.
Sociodemographic variables, comorbidities, medication history, and ED returns within 30 days after discharge were collected from patient interviews and chart reviews.
Patients who reported no use of prescription opioids at home and were discharged with a new opioid prescription were classified as Group 1.
Patients reporting use of prescription opioids at home and discharged with another opioid prescription were classified as Group 2.
Statistical analyses were performed using Fisher’s Exact and Wilcoxon’s Rank Sum Tests. Risk class and probability of OD was determined using the CIP-RIOSORD tool.
Conclusions
Patients newly prescribed opioids shared the same OD risk as those already utilizing opioids when using CIP-RIOSORD.
Antidepressant use and COPD history were important predictive factors for both groups.
Overall there were more predictive factors in those with new prescription opioid use.
Findings should be confirmed in a larger multi-centered study.