Dosing Variability Appears to Increase Risk of Opioid Overdose

Variability in long-term opioid dosing is associated with an increased risk of opioid overdose, according to a study in JAMA Network Open.

“Although there could be numerous reasons why patients are exposed to dose variability, one reason is an attempt to taper or discontinue opioid therapy,” researchers wrote. “An attempted dose reduction may be associated with opioid withdrawal or increased short-term pain, prompting patients to request a subsequent dose increase. Because of loss of tolerance after a period of reduced opioid exposure, such dose adjustments may be associated with increased risk of opioid overdose.”

The nested case-control study included 228 patients who experienced an opioid overdose and 3547 patients who did not and served as a control group. The average length of opioid therapy was 36.7 months for patients who experienced opioid overdose and 33.0 months for patients in the control group.

High variability in opioid dosing, researchers found, was linked with a more than 3 times greater risk of opioid overdose independent of opioid dose.

Consequently, researchers advised prescribers to try to minimize dose variability in patients receiving long-term opioid therapy.

“Additional studies are needed to better understand the pathways by which patients undergoing long-term opioid therapy can safely discontinue opioid therapy,” researchers wrote. “Until such pathways can be elucidated, policymakers and physicians should consider the risks that may be associated with dose variability when designing and implementing new policies to reduce opioid prescribing.”

—Jolynn Tumolo

Reference

Glanz JM, Binswanger IA, Shetterly SM, Narwaney KJ, Xu S. Association between opioid dose variability and opioid overdose among adults prescribed long-term opioid therapy. JAMA Network Open. 2019 Apr 5;2(4):e192613.