What makes people more likely to overdose on opioids?

Opioid prescription numbers have fallen in recent years, after health care providers became more aware of the risks of overdoses and the federal government tightened prescribing rules. While opioids were dispensed in 2012 at a rate of 81 prescriptions for every 100 Americans, that rate has nearly halved by 2020, according to data from the U.S. Centers for Disease Control and Prevention. However, the number of prescription opioid overdoses has remained high. In 2020, more than 68,000 overdose deaths in the U.S. were an illicit or prescription opioid, up from about 21,000 in 2010.
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Researchers are trying to predict who is most at risk for opioid overdose — and they’re finding that some Americans are more at risk than others. A new study published in JAMA network opened has found that a person’s age, gender, race, insurance type, and more can all pose a greater risk.

In the JAMA In the study, researchers looked at data from nearly 237,000 adults in Oregon who had no history of opioid use, but were prescribed them in 2015. They followed the data for another three years and found that 667 people had fatal or nonfatal opioid overdoses during that time: a rate of about 3 in 1,000. This is a relatively high rate for a population with no history of opiate use, said Dr. Scott Weiner, study co-author and associate professor of emergency medicine at Harvard Medical School. “Getting an opiate prescription just puts you at risk of overdose.”

Weiner and his team teased several risk factors that appeared to put certain Oregon patients at higher risk of overdose. Men, who are more likely than women to take a drug overdose, were 29% more likely to overdose than women in this group; residents of metropolitan counties were 51% more likely to overdose than those who did not live in cities, and black patients were 55% more likely to overdose than white patients. (The authors note, however, that since nearly 87% of Oregon’s residents are white, this may not be representative of the entire country.)

Being older seems to put people at a particularly increased risk. People aged 75 and older were about three times more likely to overdose than people aged 35 to 44. This is particularly worrisome because older adults are more vulnerable to overdose in several ways; for example, they have a weaker ability to metabolize opiates than younger people.

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Use of certain types of insurance was also linked to a higher chance of overdose. Patients with Medicaid or Medicare Advantage — an insurance plan offered by some private companies that serves as a substitute for Medicare — were more likely to overdose than those with commercial insurance. People eligible for both Medicaid and Medicare Advantage were particularly vulnerable, and were more than four times more likely to be at risk of overdose than those with commercial insurance. The type of insurance a person uses can indicate whether they face other risks, including food, housing, and job insecurity, which other research has shown people are also at higher risk for overdose, Weiner says. “Social factors really play a role in this,” he says.

But even people at higher risk for overdose shouldn’t lose access to opioids if they’re in severe pain, Weiner says. Although prescriptions for opioids are widespread in the US, some demographics have historically had insufficient access to them, including black patients. In part, experts attribute this discrepancy to racism and bias among prescribers; Healthcare providers have been shown to underestimate the pain of black patients. What the new research suggests instead, Weiner says, is that both patients and prescribers should take steps to ensure they approach opiates with caution, especially if patients have risk factors that put them at greater risk of overdose.

Health care providers can help reduce the risk by taking certain precautions, Weiner says. One is to prescribe non-opioid drugs whenever possible (or tell patients to use them as soon as their pain subsides) and to ensure that patients are educated about the use of opioids and how to dispose of them safely. When a patient has one or more risk factors, such as those identified by Weiner and his team, healthcare providers should consider spending more time with them to make sure they know how to safely use the medication, or call them to to check after their visit, Weiner says. Providers can also use several tools to more judiciously dispense these medications, including checking their state’s prescription drug monitoring programs to see patients’ prescribing histories, and prescribing the smallest possible dosage that will adequately treat a person’s pain.

Patients and their loved ones can also help reduce the risk of overdose. Patients and their families should recognize that opioids are only intended to help with the worst pain and should be disposed of safely, such as at a pharmacy, Weiner says. Families should also monitor the person taking opioids for signs of tolerance, dependence, or opioid use disorder, such as a patient refilling their prescription early or taking the drug differently than they were prescribed, Weiner says. If that happens, they should contact a prescriber for help. “If they fall into the higher risk factors, that’s good for them to know,” Weiner says. “Because when they get a prescription, they should ask the prescriber how to be safe with it.”

This post What makes people more likely to overdose on opioids?

was original published at “https://time.com/6143463/opioid-overdose-risk-factors/”