A recent Canadian study found that 10 predictors are associated with the likelihood of an opioid overdose in people prescribed for chronic pain.
Monday Canadian Medical Association Journal (CMAJ) Announcement of large-scale study led by McMaster University The study found that the risk of fatal and non-fatal opioid overdose after prescription increased by up to six times in cases involving predictive factors such as high drug doses, depression, and pancreatitis. .
“What we really need to have a conversation about is opioid stewardship and responsible opioid prescribing, because we can’t get rid of opioids, and we shouldn’t get rid of them,” said Nicholson, a registered nurse and assistant professor at the University of Calgary. Jennifer Jackson explained.
“We need them to treat people who are suffering. But we also need to consider what other options are available and whether they are the best choice,” she added.
“Chronic back pain is not an appropriate use of opioids, but you can’t throw the baby out with the bathwater either… If you’re having surgery or have cancer, you need opioids. So , they are tools, but we have to use them correctly,” she said.
According to one study, approximately 7.6 million people in Canada live with chronic pain. 2021 Report by the Canadian Pain Task Force.
Pain management for chronic pain relies heavily on prescription opioid treatments such as codeine, fentanyl, morphine, and oxycodone. The evolution of the opioid crisis In Canada. This is because long-term side effects of opioid use can include increased tolerance, substance use disorder or dependence, and overdose. According to Health Canada.
To identify factors associated with fatal and nonfatal overdoses from prescription opioids, researchers examined data from 2007 to 2022 from 24 million patients in Canada, the United States, and the United Kingdom. These patients were prescribed opioids for non-cancer and cancer-related chronic pain.
“While 103 predictors were reported in this study, we found 10 to be particularly important because these predictors significantly increased the “We showed a very significant association with a two- to six-fold increased risk of opioid overdose,” Dr. Lee said. Wang is a co-author and assistant professor of anesthesiology at the McMaster School of Health Sciences in Hamilton, Ont.
“We call them serious harms,” she added.
According to research, the 10 predictors strongly associated with opioid overdose are:
- high dose opioids
- Use multiple pharmacies
- Multiple opioid prescribers
- fentanyl prescription
- Current substance use disorder
- depression
- bipolar disorder
- Other mental illnesses
- History of opioid overdose
- pancreatitis
“These are very important risk factors,” Wang said. “We hope that in the future we can find more harm reduction strategies to prevent or shift this type of risk and prevent future fatal or non-fatal overdoses. That’s the goal. is.”
Highest risk factor for opioid overdose
Jackson called the study “solid” and said the findings “add to what we already know about chronic opioid use.”
One of the most significant risk factors for opioid addiction or overdose, identified by researchers and Jackson, is the habit of obtaining opioids from multiple pharmacies or multiple prescribers.
“We call it doctor shopping or pharmacy shopping,” Wang said. “Patients tend to use multiple pharmacies and prescriptions to obtain opioids.”
The study found that patients who seek opioids from multiple prescribers or pharmacies are nearly five times more likely to overdose.
“Those are pretty serious red flags that someone is engaging in unhealthy behaviors when it comes to opioid use. And rather than saying, ‘I’m going to try to cut off connections from various providers,’ it’s the behavior that escalates.” If we are starting to see this, we need to discuss it. If that person has consent and wants support, how can we provide support?” Jackson said.
Researchers and Jackson see this as a “warning sign” that requires engagement rather than “cancellation.”
This is because when a person is addicted to opioids, they are “physiologically unable to simply stop taking them,” Jackson said. “Withdrawal is life-threatening and can be fatal if the body’s biochemistry changes and there is no longer an option.”
Another notable risk factor was the use of “high doses of opioids,” as Wang explained.
of Canadian guidelines For opioids for non-cancer chronic pain, we strongly recommend that prescription doses be less than 90 milligrams.
The study found that if a patient received a prescription for more than 90 milligrams, the risk of overdosing increased 2.6 times.
Previous research conducted by Canadian Institute for Health Information (CIHI), 2019 corroborated these findings and highlighted the increased risks associated with high doses of opioids. The study found that patients prescribed opioid doses greater than 90 milligrams per day had an increased risk of drug-related death compared to patients prescribed lower doses.
According to this study, the most prominent risk factor for overdose is its association with a history of past overdoses, making people almost six times more likely to experience an overdose.
Wang said he hopes these 10 predictors will help create collaborative decision-making between doctors and patients regarding prescribing opioids for chronic pain. The goal is to evaluate potential harms in relation to the potential benefits of treatment.
“Our findings could help doctors and patients struggling with chronic pain management,” she said. “Support[patients]in the decision-making process about whether to use opioids for chronic management or whether to pay attention to other factors.”
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