Opioid discontinuation after overdose was associated with lower risk for repeated overdose, yet nearly all patients continued to receive prescription opioids after an overdose. This according to a study of 2,848 patients aged 18 to 64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain. Researchers found:

• Over a median follow-up of 299 days, opioids were dispensed to 91% of patients after an overdose.

• 7% of patients (n=212) had a repeated opioid overdose.

• At 2 years, the cumulative incidence of repeated overdose was 17% for patients receiving high dosages of opioids after the index overdose, 15% for those receiving moderate dosages, 9% for those receiving low dosages, and 8% for those receiving no opioids.

Citation: Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam FJ. Opioid prescribing after nonfatal overdose and association with repeated overdose. [Published online ahead of print December 29, 2015]. Ann Intern Med. doi: 10.7326/M15-0038.

Commentary: This study suggests that patients who have had an admission for opioid overdose are at significant risk for another overdose. This is not surprising. The study does heighten our awareness of this issue and suggests that the decision to continue to treat with opioids needs to be carefully balanced with the increased risk of overdose. It also suggests that in these patients we take particular care to follow best practices with regard to prescribing, including education about use and random urine drug testing. That said, this is a challenging population to take care of – they often have both pain and substance abuse issues – and they need our care. As primary care physicians, it might be attractive to refer many of these patients to specialty pain offices, but the reality is that often there are not sufficient pain practices in the area to care for these patients and we are left, with this heightened awareness, to do our best to provide them excellent and safe care. —Neil Skolnik, MD