Oklahoma City, OK—Pharmacists should keep an eye out for concurrent prescriptions for high opioid doses and benzodiazepine sedatives, especially in Medicaid recipients, a new study suggests.

That is among the potentially modifiable risk factors for fatal overdose, according to the report in the journal Medical Care.

University of Oklahoma College of Pharmacy researchers reviewed the state’s Medicaid and Department of Health data from 2011 to 2016, identifying 639 Medicaid members who died of an unintentional prescription opioid overdose. Of those, they found that 321 patients had at least one Medicaid-covered opioid prescription in the year before death.

The deceased patients with opioid prescriptions averaged age 44.5 years, were 64% female and 81% white, and were matched to 963 living Medicaid recipients with similar characteristics, including opioid prescriptions. The study team analyzed demographic factors, clinical characteristics, and medical/pharmacy use in the past year to identify individual-level risk factors for prescription opioid overdose.

The researchers reported that Medicaid patients who died of opioid overdose were more likely to:
• Have common causes of chronic pain, especially neck or joint pain and low back pain
• Have been diagnosed with opioid dependence or to have other types of drug toxicity
• Have been diagnosed with hepatitis, a common complication in people with addiction disorders
• To have been diagnosed with certain psychiatric disorders, particularly bipolar disorder or schizophrenia

“Prescribers and state agencies should be aware of these addressable patient-level factors among the Medicaid population,” study authors write. “Targeting these factors with appropriate policy interventions and education may prevent future deaths.”

One of the key risk factors in mortality was receiving higher-dose opioid prescriptions, according to the research, which found that patients in the two highest dose categories had three times the odds of fatal opioid overdose versus the control group.

Concurrent use of benzodiazepines also increased risk, they write, with about 29% of patients who died of prescription opioid overdose having been using both drug classes. In fact, the study team notes, the odds of death shot up with as little as 1 to 6 days of overlap between opioids and benzodiazepines.

Because about half of the Oklahoma Medicaid patients who died of prescription-drug overdose during the study period did not have a covered prescription claim in the year before death, the researchers posit that they “obtained their prescriptions through other insurance coverage, other forms of payment, or diversion.”

Study authors suggest that their findings “may contribute to recommendations for establishing rational opioid dose thresholds and use of benzodiazepines in clinical guidelines and government policies.” They recommend the use of prescription-drug monitoring programs and care-coordination models to help stem the tide of opioid deaths.

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