Prescription Opioid Dispensing Patterns Prior to Heroin Overdose in a State Medicaid Program: a Case-Control Study

Background A large proportion of individuals who use heroin report initiating opioid use with prescription opioids. However, patterns of prescription opioid use preceding heroin-related overdose have not been described. Objective To describe prescription opioid use in the year preceding heroin overd...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2020-11, Vol.35 (11), p.3188-3196
Main Authors: Hartung, Daniel M., Johnston, Kirbee A., Hallvik, Sara, Leichtling, Gillian, Geddes, Jonah, Hildebran, Christi, Keast, Shellie, Chan, Brian, Korthuis, P. Todd
Format: Article
Language:English
Subjects:
Analgesics, Opioid - therapeutic use
Benzodiazepines
Case-Control Studies
Central nervous system
Central nervous system depressants
Confidence intervals
Drug overdose
Drug Overdose - drug therapy
Drug Overdose - epidemiology
Government programs
Heroin
Humans
Internal Medicine
Medicaid
Medicine
Medicine & Public Health
Morphine
Narcotics
Opioids
Oregon - epidemiology
Original Research
Overdose
Prescriptions
Therapeutic drug monitoring
United States - epidemiology
Vital statistics
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Summary:Background A large proportion of individuals who use heroin report initiating opioid use with prescription opioids. However, patterns of prescription opioid use preceding heroin-related overdose have not been described. Objective To describe prescription opioid use in the year preceding heroin overdose. Design Case-control study comparing prescription opioid use with a heroin-involved overdose, non-heroin-involved opioid overdose, and non-overdose controls from 2015 to 2017. Participants Oregon Medicaid beneficiaries with linked administrative claims, vital statistics, and prescription drug monitoring program data. Main Measures Opioid, benzodiazepine, and other central nervous system depressant prescriptions preceding overdose; among individuals with one or more opioid prescription, we assessed morphine milligram equivalents per day, overlapping prescriptions, prescriptions from multiple prescribers, long-term use, and discontinuation of long-term use. Key Results We identified 1458 heroin-involved overdoses (191 fatal) and 2050 non-heroin-involved opioid overdoses (266 fatal). In the 365 days prior to their overdose, 45% of individuals with a heroin-involved overdose received at least one prescribed opioid compared with 78% of individuals who experienced a non-heroin-involved opioid overdose ( p  
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-020-06192-4