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Understanding opioid overdose characteristics involving prescription and illicit opioids: A mixed methods analysis.
Drug Alcohol Depend. 2016 Oct 01; 167:49-56.DA

Abstract

BACKGROUND

Opioid abuse and misuse are significant public health issues. The CDC estimated 72% of pharmaceutical-related overdose deaths in the US in 2012 involved opioids. While studies of opioid overdoses have identified sociodemographic characteristics, agents used, administration routes, and medication sources associated with overdoses, we know less about the context and life circumstances of the people who experience these events.

METHODS

We analyzed interviews (n=87) with survivors of opioid overdoses or family members of decedents. Individuals experiencing overdoses were members of a large integrated health system. Using ICD codes for opioid overdoses and poisonings, we identified participants from five purposefully derived pools of health-plan members who had: 1) prescriptions for OxyContin(®) or single-ingredient sustained-release oxycodone, 2) oxycodone single-ingredient immediate release, 3) other long-acting opioids, 4) other short-acting opioids, or 5) no active opioid prescriptions.

RESULTS

Individuals who experienced opioid overdoses abused and misused multiple medications/drugs; experienced dose-related miscommunications or medication-taking errors; had mental health and/or substance use conditions; reported chronic pain; or had unstable resources or family/social support. Many had combinations of these risks. Most events involved polysubstance use, often including benzodiazepines. Accidental overdoses were commonly the result of abuse or misuse, some in response to inadequately treated chronic pain or, less commonly, medication-related mistakes. Suicide attempts were frequently triggered by consecutive negative life events.

CONCLUSIONS

To identify people at greater risk of opioid overdose, efforts should focus on screening for prescribed and illicit polysubstance use, impaired cognition, and changes in life circumstances, psychosocial risks/supports, and pain control.

Authors+Show Affiliations

Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: bobbijo.h.yarborough@kpchr.org.Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: scott.p.stumbo@kpchr.org.Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: shannon.l.janoff@kpchr.org.Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: micah.yarborough@kpchr.org.Department of Public Health & Preventive Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Hill Road, CB 669, Portland, OR 97239, USA. Electronic address: mcartyd@ohsu.edu.Purdue Pharma, L.P. One Stamford Forum, Stamford, CT 06901, USA. Electronic address: howard.chilcoat@pharma.com.Purdue Pharma, L.P. One Stamford Forum, Stamford, CT 06901, USA. Electronic address: paul.coplan@pharma.com.Kaiser Permanente Northwest Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA. Electronic address: carla.a.green@kpchr.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27520885

Citation

Yarborough, Bobbi Jo H., et al. "Understanding Opioid Overdose Characteristics Involving Prescription and Illicit Opioids: a Mixed Methods Analysis." Drug and Alcohol Dependence, vol. 167, 2016, pp. 49-56.
Yarborough BJ, Stumbo SP, Janoff SL, et al. Understanding opioid overdose characteristics involving prescription and illicit opioids: A mixed methods analysis. Drug Alcohol Depend. 2016;167:49-56.
Yarborough, B. J., Stumbo, S. P., Janoff, S. L., Yarborough, M. T., McCarty, D., Chilcoat, H. D., Coplan, P. M., & Green, C. A. (2016). Understanding opioid overdose characteristics involving prescription and illicit opioids: A mixed methods analysis. Drug and Alcohol Dependence, 167, 49-56. https://doi.org/10.1016/j.drugalcdep.2016.07.024
Yarborough BJ, et al. Understanding Opioid Overdose Characteristics Involving Prescription and Illicit Opioids: a Mixed Methods Analysis. Drug Alcohol Depend. 2016 Oct 1;167:49-56. PubMed PMID: 27520885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Understanding opioid overdose characteristics involving prescription and illicit opioids: A mixed methods analysis. AU - Yarborough,Bobbi Jo H, AU - Stumbo,Scott P, AU - Janoff,Shannon L, AU - Yarborough,Micah T, AU - McCarty,Dennis, AU - Chilcoat,Howard D, AU - Coplan,Paul M, AU - Green,Carla A, Y1 - 2016/08/01/ PY - 2015/11/23/received PY - 2016/04/12/revised PY - 2016/07/21/accepted PY - 2016/8/14/entrez PY - 2016/8/16/pubmed PY - 2017/10/19/medline KW - Intervention KW - Opioid analgesics KW - Overdose KW - Prevention KW - Risk SP - 49 EP - 56 JF - Drug and alcohol dependence JO - Drug Alcohol Depend VL - 167 N2 - BACKGROUND: Opioid abuse and misuse are significant public health issues. The CDC estimated 72% of pharmaceutical-related overdose deaths in the US in 2012 involved opioids. While studies of opioid overdoses have identified sociodemographic characteristics, agents used, administration routes, and medication sources associated with overdoses, we know less about the context and life circumstances of the people who experience these events. METHODS: We analyzed interviews (n=87) with survivors of opioid overdoses or family members of decedents. Individuals experiencing overdoses were members of a large integrated health system. Using ICD codes for opioid overdoses and poisonings, we identified participants from five purposefully derived pools of health-plan members who had: 1) prescriptions for OxyContin(®) or single-ingredient sustained-release oxycodone, 2) oxycodone single-ingredient immediate release, 3) other long-acting opioids, 4) other short-acting opioids, or 5) no active opioid prescriptions. RESULTS: Individuals who experienced opioid overdoses abused and misused multiple medications/drugs; experienced dose-related miscommunications or medication-taking errors; had mental health and/or substance use conditions; reported chronic pain; or had unstable resources or family/social support. Many had combinations of these risks. Most events involved polysubstance use, often including benzodiazepines. Accidental overdoses were commonly the result of abuse or misuse, some in response to inadequately treated chronic pain or, less commonly, medication-related mistakes. Suicide attempts were frequently triggered by consecutive negative life events. CONCLUSIONS: To identify people at greater risk of opioid overdose, efforts should focus on screening for prescribed and illicit polysubstance use, impaired cognition, and changes in life circumstances, psychosocial risks/supports, and pain control. SN - 1879-0046 UR - https://www.unboundmedicine.com/medline/citation/27520885/Understanding_opioid_overdose_characteristics_involving_prescription_and_illicit_opioids:_A_mixed_methods_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0376-8716(16)30221-6 DB - PRIME DP - Unbound Medicine ER -