ORIGINAL CONTRIBUTION AssociationBetweenOpioidPrescribingPatterns and Opioid Overdose-Related Deaths

THE RATE OF OVERDOSE MORTALity increased sharply in the United States in the past decade and overdose mortality is a pressing public health problem. Between 1999 and 2007, the rate of unintentional overdose death in the United States increased by 124%, largely because of increases in prescription opioid overdoses. Achieving a better understanding of the factors contributing to prescription opioid overdose death is an essential step toward addressing this troubling and dramatic increase in overdose mortality. There is some evidence that higher prescribed doses increase the risk of drug overdose among individuals treated with opioids for chronic noncancer pain. Specifically, the risk of drug-related adverse events is higher among individuals prescribed opioids at doses equal to 50 mg/d or more of morphine. The association of opioid prescribing patterns with risk of overdose may vary across groups of patients; opioid treatment recommendations for pain are typically specific to particular subgroups such as those with chronic noncancer pain, cancer-related pain, and substance use disorders. However, potential subgroup differences in overdose risk related to opioid prescribing have not been examined.