June 10, 2016
In the U.S., prescriptions for and sales of opioid painkillers have nearly quadrupled since 1999, according to the Centers for Disease Control and Prevention. Researchers from the University of Michigan Medical School and the Department of Veterans Affairs' Ann Arbor Healthcare System published a new study in the online journal Medical Care exposing a major problem in prescribing these powerful drugs: the dosage may make the difference between life or death.
The researchers examined data from 221 veterans who died from accidental opioid painkiller overdoses compared to data from same number of similar patients who also took opioids for chronic pain but did not overdose.
According to the study results, the average dose prescribed to the overdose victims was much higher – on average, 71 percent higher – compared to the other group.
In a press release from the University of Michigan, Amy Bohnert, MHS, Ph.D., VA/U-M, first author of the new study, explained:
“As the United States grapples with the rising toll of accidental overdoses due to opioids, our findings suggest that changing clinical practices to avoid escalating doses for patients with chronic pain could make a major difference in the number of patients who die.”
According to Bohnert, an epidemiologist who specializes in studying opioid use and abuse, keeping per-pill dosages low would protect not only patients, but others who may have illicit access to the drug, such as young people in the patients’ homes.
“Avoiding prescribing large doses also has the benefit of reducing the amount of the medications going to patients’ homes that has the potential to be taken by others who live with the patient, like children and teenagers,” Bohnert added. “This is important because an opioid that is a larger dose per pill, compared to a smaller one, is going to be deadly to a child or adult who hasn’t been taking the medication regularly.”
In the group of veterans studied for the UM paper, less than 25 percent of the non-overdosing veterans received prescriptions for daily doses above 50 MEM while 60 percent of those who overdosed were prescribed over 50 MEM per day. This dosage measurement is morphine milligram equivalents or MME, sometimes written as morphine-equivalent milligrams or MEM, which describes differences in the strength of various prescription opioid painkillers.
Bohnert was also a member of the Core Expert Group charged by the CDC with the development of new guidelines for prescribing opioid painkillers. The new proposed CDC guidelines address:
Overall the CDC gave 12 distinct recommendations including:
The CDC also created a checklist to help physicians determine if prescribing opioids is the best course of treatment.
“Determining whether opioid painkillers are appropriate for a patient and at what dosage is not an easy answer,” states Dr. Lousine Alpern. “In many situations our reviews have resulted in our patients being put on better regimens that have positively impacted patient care. We actively discuss through peer-to-peer calls with providers the alternatives available that can lead to better optimized pain regimens and stronger outcomes.”
To learn more about optimized care through review you can review our infographic from July 2015.
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