Largest study of opioid deaths reveals who is at most risk
New York, NY (November 28, 2017)–Just over 60 percent of individuals who died from an opioid overdose had been diagnosed with a chronic pain condition, and many had been diagnosed with a psychiatric disorder, a study of more than 13,000 overdose deaths has found. The study, led by researchers at Columbia University Medical Center (CUMC), is the first to determine the proportion of those who died of an opioid overdose with chronic pain.
The findings were published online today in the American Journal of Psychiatry.
According to the US Centers for Disease Control, the number of opioid-related deaths has quadrupled, from 8,048 in 1999 to 33,091 in 2015.
The researchers analyzed clinical diagnoses and filled medication prescriptions for more than 13,000 adults in the Medicaid program who died of an opioid overdose. During the last year of life, more than half of these individuals had been diagnosed with chronic pain. Many had also been diagnosed with depression and anxiety. "The frequent occurrence of treated chronic pain and mental health conditions among overdose decedents underscores the importance of offering substance use treatment services in clinics that treat patients with chronic pain and mental health problems. Such a strategy might increase early clinical intervention in patients who are at high risk for fatal opioid overdose," said Mark Olfson, MD, professor of psychiatry at CUMC and lead investigator of the study.
Approximately one-third of those who died had been diagnosed with a drug use disorder in the prior year. However, fewer than one in twenty had been diagnosed with opioid use disorder in the last month. "Because clinical diagnoses generally indicate treatment, this service pattern suggests that dropout from drug treatment is common before fatal opioid overdose. Improving treatment retention with contingency management or other effective behavioral interventions might help lower the risk of fatal overdose in these patients," said Dr. Olfson.
In the year before death, more than half had filled prescriptions for opioids or benzodiazepines, and many had filled prescriptions for both types of medications. "This medication combination is known to increase the risk of respiratory depression, which is the unusually slow and shallow breathing that is the primary cause of death in most fatal opioid overdoses," said Dr. Olfson, who added that the data from the current study were collected between 2001 and 2007. "In the years since, there has been an increase in the proportion of US overdose deaths involving benzodiazepines and opioids." The authors urged providers to restrict the combination, in the lowest possible dose and duration, to those patients for whom alternative strategies have proven inadequate.
The study is titled, "Service Use Preceding Opioid-Related Fatality."
The other contributors are Melanie Wall (CUMC), Shuai Wang (CUMC), Stephen Crystal (Rutgers, the State University of New Jersey, New Brunswick, NJ), and Carlos Blanco (National Institute on Drug Abuse, Rockville, MD).
The study was funded by the Agency for Healthcare Research and Quality (U19 HS021112), the National Institute on Drug Abuse (R01 DA019606), and the New York Psychiatric Institute.
The authors report no financial or other conflicts of interest.
Columbia University Department of Psychiatry
Columbia Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at Columbia University's College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.
Columbia University Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. The campus that Columbia University Medical Center shares with its hospital partner, NewYork-Presbyterian, is now called the Columbia University Irving Medical Center. For more information, visit cumc.columbia.edu or columbiadoctors.org.