Comprehensive analysis of U.S. prescription opioid users and overdose cases further supports personalized approach to prescription of opioids.
RICHMOND, Va. – DECEMBER 21, 2017 – Individuals suffering from a substance use disorder (SUD) or depression are among those at highest risk for a serious prescription opioid overdose, according to a study slated for the January print edition of Pain Medicine.
The retrospective, case-control study analyzed and compared patients with an opioid prescription from two health care claims databases: the U.S. Veterans Health Administration (VHA) from 2010-12 (1.9 million patients) and a U.S. commercial health plan database (IMS PharMetrics Plus) from 2009-13 (18.3 million patients). Risk factors for overdose in the 7,234 overdose cases in the commercially insured population (CIP) were analyzed and compared with the risk factor profile for the 817 VHA overdose cases. This is the most comprehensive characterization and comparison published to date of U.S. medical users of prescription opioids and overdose cases.
The strongest risk factors for prescription opioid overdose in the CIP were diagnosed depression and SUD of any type — not just opioid dependence, abuse or addiction. Other strongly associated factors included other mental health disorders; impaired liver, kidney, vascular or lung function; and non-cancer pancreatic disease. A high total daily opioid dose, certain opioids and extended-release or long-acting opioids also were strong predictors of overdose. Taking certain other medications that affect the mind or behavior, such as benzodiazepines or antidepressants, increased an opioid user’s risk of overdose.
The risk factor profiles largely were similar between the two populations despite substantial population differences in demographics, pre-existing health conditions, current medications, recent emergency department visits and hospitalizations, as well as differences between the public and private health care systems including medication prescribing practices and drug formularies.
The prevalence of prescribing higher total daily opioid doses, all opioids except morphine and methadone, and most non-opioid medications, including psychoactive drugs, was considerably greater in the CIP overall than in the VHA population. However, extended-release or long-acting opioids were prescribed only about half as frequently among overdose cases in the CIP as in VHA.
Prescription opioid sales have quadrupled in the United States between 1999 and 2010, and opioid prescription use increased by 31 percent between 2000 and 2005 among commercially insured patients. Between 2004 and 2012, opioid use increased 77 percent among VHA patients.
Pain management is complex and multidimensional, and the risk of an opioid overdose is dependent on multiple factors.
“Any treatment plan involving opioids requires an individualized approach due to the potential for a serious overdose in all patients, regardless of their age or reason for using opioids,” said Barbara Zedler, M.D., senior author and chief medical officer of Venebio, a life sciences consultancy. “Safe and appropriate opioid prescribing requires a personalized approach that accounts for a patient’s demographic and psychosocial characteristics, health conditions, other medications and substances used, and opioid-specific characteristics.”
Venebio is the developer of the only validated opioid risk-screening tool — Venebio Opioid Advisor™ (VOA™) – that predicts a patient’s likelihood of experiencing a life-threatening opioid overdose with 90-percent accuracy. VOA uses a proprietary algorithm to develop a personalized risk profile based on multiple demographic and clinical variables associated with prescription opioid overdose.
Venebio Opioid Advisor has been implemented by several health care organizations, including Amida Care and Virginia Premier Health Plan, to screen for patients at risk of experiencing a prescription opioid overdose.
The study, “Risk Factors for Serious Prescription Opioid-induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations” was co-funded by Venebio and Kaléo, Inc., a privately held pharmaceutical company. The full study is currently available at: https://academic.oup.com/painmedicine/article/3611356/Risk-Factors-for-Serious-Prescription-Opioid and additional information is available at voa.venebio.com.
About Venebio Group
Venebio is a research consultancy that provides cost-effective, custom solutions for complex life sciences problems. By integrating the expertise of a global network of scientists in a broad range of biomedical fields, Venebio delivers comprehensive project management and problem solving in genetic and molecular epidemiology, pharmacoepidemiology and pharmacovigilance, personalized medicine, bioinformatics, biomarker discovery, and epidemiologic literature reviews and analysis. Learn more at www.venebio.com and voa.venebio.com.
 Paulozzi L, Jones C, Mack KA, Rudd R. Vital signs: Overdoses of prescription opioid pain relievers – United States, 1999-2008. MMWR Morb Mortal Wkly Rep 2011;60(43):1487-92.
 Sullivan MD, Edlund MJ, Fan MY, et al. Trends in use of opioids for non-cancer pain conditions 2000-2005 in commercial and Medicaid insurance plans: The TROUP study. Pain 2008; 138(2):440-9.
 Mosher HJ, Krebs EE, Carrel M, et al. Trends in prevalent and incident opioid receipt: An observational study in Veterans Health Administration 2004-2012. J Gen Intern Med 2015;30(5):597-604.