However, in some individuals, opioid prescriptions produce a pathway for misuse, abuse and risk of opioid overdose death. In two previous posts, I have outlined the epidemiology of opioid overdose death and the toxicology of these compounds.
Risk factors for the development of prescription opioid drugs have not been extensively studied. However, it is reasonable to think that risks for prescription opioid abuse might be similar to the known risk factors for alcohol abuse and non-prescription drug abuse. These general risk factors for substance abuse include:
- Male gender
- Family history of alcoholism or drug abuse
- Nicotine dependence
- Antisocial personality disorder
- Pre-existing mood or anxiety disorder
- Early age onset of of alcohol or other drug use
- Peer group substance use and approval of drinking/drug use
- Accessibility and affordability of alcohol/drug substance
Although studies examining risk factors for prescription drug abuse are limited, one recent study published in journal Pain Medicine examined characteristics of a series of cases of overdose deaths in individuals prescribed controlled substances.
Individuals who died of an unintentional drug overdose in the state of New Mexico over an 18 month period were identified. A control group of individuals were identified based on recently receiving prescriptions utilizing a state prescription monitoring database.
This case control study found some interesting risk factors associated with unintentional drug overdose deaths including:
- Male gender
- Older age
- Sedative/hypnotic prescriptions
- Multiple prescriptions for controlled substances
- Prescriptions from multiple providers and multiple pharmacies
- Specific prescriptions for buprenorphine, fentanyl, hydromorphone (Dilaudid), methadone, or oxycodone (Oxycontin)
- Daily opioid prescription dose greater than the equivalent of 40 mg of morphine
This study found prescriptions for at least one controlled substance was found in 44% of all individuals 10 years and older during the study period.
The authors conclude their study supports the potential for centralized state pharmacy controlled substance databases to reduce the numbers of unintentional overdose deaths. Such databases could alert providers and pharmacies to high-risk individuals who may be abusing the medical system. Such programs would not address other potential access routes such as purchase of controlled prescription drugs off the street or via internet orders.
In the next post, I will review some of the recent research related to pharmacological approaches to the treatment of opioid abuse and dependence.
Photo of sea gull flying over Arkansas River near Tulsa, Oklahoma from the author's files.
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