Opioid Dose Variability Associated with Overdose

Science Spotlight

Prescription pain pills tumble from container
Image by ©iStock.com/dptulk

As health care providers lower opioid doses for pain patients to minimize the risk of addiction; increase doses to manage worsening pain; or re-start dosing after a period of time without opioid pain relievers, patients could be getting confused about safe dose levels, putting them at risk for overdose. A new study funded by the National Institute on Drug Abuse found that high dose variability increases the odds for an opioid overdose independent of dose alone. Even among patients receiving low doses of opioids, dose variability increases the risk of overdose.

The study followed long-term opioid therapy patients enrolled in Kaiser Permanente Colorado, from January 1, 2006 to December 31, 2017. The study matched 228 patients who had experienced an opioid overdose with 3,547 control patients who had not experienced an opioid overdose.

Results suggested that more dose variability correlates with a more than three-fold increase in overdose risk. The authors suggested patients in long-term opioid therapy are exposed to changes in dose for a variety of reasons, including worsened pain, practitioner-initiated tapers, changing physicians, missed appointments, poor adherence to urine toxicology screening, or travel. The periods of greatest risk could follow abrupt changes in dosage, such as resuming opioid use after a period with no pain reliever use, prompting patients to seek a dose that may heighten their risk for overdose. Alternatively, a dose reduction may cause patients to seek pharmaceutical opioids from other sources.

These findings suggest that practitioners should: seek to minimize dose variability when managing long-term opioid therapy; pursue careful dose monitoring; and exercise caution in designing and implementing policies to reduce opioid prescribing. Tapering patients off long-term opioid therapy may be beneficial if it ultimately leads to the discontinuation of opioid therapy, but it also may result in dose variability associated with an increased risk of overdose.

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, funded this study. Investigators at Kaiser Permanente’s Institute for Health Research led the research team.

For a copy of the article, published in JAMA Network Open, go to Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy.

For more information, contact the NIDA press office at media@nida.nih.gov or 301-443-6245. Follow NIDA on Twitter and Facebook.

NIDA Press Office

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®