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Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History.
J Urban Health. 2019 02; 96(1):38-48.JU

Abstract

Opioid overprescribing is a major driver of the current opioid overdose epidemic. However, annual opioid prescribing in the USA dropped from 782 to 640 morphine milligram equivalents per capita between 2010 and 2015, while opioid overdose deaths increased by 63%. To better understand the role of prescription opioids and health care utilization prior to opioid-related overdose, we analyzed the death records of decedents who died of an opioid overdose in Illinois in 2016 and linked to any existing controlled substance monitoring program (CSMP) and emergency department (ED) or hospital discharge records. We found that of the 1893 opioid-related overdoses, 573 (30.2%) decedents had not filled an opioid analgesic prescription within the 6 years prior to death. Decedents without an opioid prescription were more likely to be black (33.3% vs 20.2%, p < .001), Hispanic (16.3% vs 8.8%, p < .001), and Chicago residents (46.8% vs 25.6%, p < .001) than decedents with at least one filled opioid prescription. Decedents who did not fill an opioid prescription were less likely to die of an overdose involving prescribed opioids (7.3% vs 19.5%, p < .001) and more likely to fatally overdose on heroin (63% vs 50.4%, p < .001) or fentanyl/fentanyl analogues (50.3% vs 41.8%, p = .001). Between 2012 and the time of death, decedents without an opioid prescription had fewer emergency department admissions (2.5 ± 4.2 vs 10.6 ± 15.8, p < .001), were less likely to receive an opioid use disorder diagnosis (41.3% vs 47.5%, p = .052), and were less likely to be prescribed buprenorphine for opioid use disorder treatment (3.3% vs 8.6%, p < .001). Public health interventions have often focused on opioid prescribing and the use of CSMPs as the core preventive measures to address the opioid crisis. We identified a subset of individuals in Illinois who may not be impacted by such interventions. Additional research is needed to understand what strategies may be successful among high-risk populations that have limited opioid analgesic prescription history and low health care utilization.

Authors+Show Affiliations

University of Chicago Pritzker School of Medicine, Chicago, IL, USA. ali.abbasi@uchospitals.edu. Illinois Department of Public Health, Chicago, IL, USA. ali.abbasi@uchospitals.edu.Center for Multi-System Solutions to the Opioid Epidemic, American Institutes for Research, Chicago, IL, USA.Division of Patient Safety and Quality, Illinois Department of Public Health, Chicago, IL, USA.Prescription Monitoring Program, Illinois Department of Human Services, Chicago, IL, USA.Cook County Chief Medical Examiner, Chicago, IL, USA.Department of Emergency Medicine, Cook County Health and Hospitals System, Chicago, IL, USA.Illinois Department of Public Health, Chicago, IL, USA.Illinois Department of Public Health, Chicago, IL, USA. Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

30607879

Citation

Abbasi, Ali B., et al. "Health Care Utilization of Opioid Overdose Decedents With No Opioid Analgesic Prescription History." Journal of Urban Health : Bulletin of the New York Academy of Medicine, vol. 96, no. 1, 2019, pp. 38-48.
Abbasi AB, Salisbury-Afshar E, Jovanov D, et al. Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History. J Urban Health. 2019;96(1):38-48.
Abbasi, A. B., Salisbury-Afshar, E., Jovanov, D., Berberet, C., Arunkumar, P., Aks, S. E., Layden, J. E., & Pho, M. T. (2019). Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 96(1), 38-48. https://doi.org/10.1007/s11524-018-00329-x
Abbasi AB, et al. Health Care Utilization of Opioid Overdose Decedents With No Opioid Analgesic Prescription History. J Urban Health. 2019;96(1):38-48. PubMed PMID: 30607879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History. AU - Abbasi,Ali B, AU - Salisbury-Afshar,Elizabeth, AU - Jovanov,Dejan, AU - Berberet,Craig, AU - Arunkumar,Ponni, AU - Aks,Steven E, AU - Layden,Jennifer E, AU - Pho,Mai T, PY - 2019/1/5/pubmed PY - 2020/7/2/medline PY - 2019/1/5/entrez KW - Controlled substance monitoring programs KW - Drug overdose prescription opioids KW - Fentanyl KW - Heroin KW - Opioid overdose SP - 38 EP - 48 JF - Journal of urban health : bulletin of the New York Academy of Medicine JO - J Urban Health VL - 96 IS - 1 N2 - Opioid overprescribing is a major driver of the current opioid overdose epidemic. However, annual opioid prescribing in the USA dropped from 782 to 640 morphine milligram equivalents per capita between 2010 and 2015, while opioid overdose deaths increased by 63%. To better understand the role of prescription opioids and health care utilization prior to opioid-related overdose, we analyzed the death records of decedents who died of an opioid overdose in Illinois in 2016 and linked to any existing controlled substance monitoring program (CSMP) and emergency department (ED) or hospital discharge records. We found that of the 1893 opioid-related overdoses, 573 (30.2%) decedents had not filled an opioid analgesic prescription within the 6 years prior to death. Decedents without an opioid prescription were more likely to be black (33.3% vs 20.2%, p < .001), Hispanic (16.3% vs 8.8%, p < .001), and Chicago residents (46.8% vs 25.6%, p < .001) than decedents with at least one filled opioid prescription. Decedents who did not fill an opioid prescription were less likely to die of an overdose involving prescribed opioids (7.3% vs 19.5%, p < .001) and more likely to fatally overdose on heroin (63% vs 50.4%, p < .001) or fentanyl/fentanyl analogues (50.3% vs 41.8%, p = .001). Between 2012 and the time of death, decedents without an opioid prescription had fewer emergency department admissions (2.5 ± 4.2 vs 10.6 ± 15.8, p < .001), were less likely to receive an opioid use disorder diagnosis (41.3% vs 47.5%, p = .052), and were less likely to be prescribed buprenorphine for opioid use disorder treatment (3.3% vs 8.6%, p < .001). Public health interventions have often focused on opioid prescribing and the use of CSMPs as the core preventive measures to address the opioid crisis. We identified a subset of individuals in Illinois who may not be impacted by such interventions. Additional research is needed to understand what strategies may be successful among high-risk populations that have limited opioid analgesic prescription history and low health care utilization. SN - 1468-2869 UR - https://www.unboundmedicine.com/medline/citation/30607879/Health_Care_Utilization_of_Opioid_Overdose_Decedents_with_No_Opioid_Analgesic_Prescription_History_ L2 - https://dx.doi.org/10.1007/s11524-018-00329-x DB - PRIME DP - Unbound Medicine ER -