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Journal Club

Journal Club. Alcohol, Other Drugs, and Health: Current Evidence January–February 2016. Featured Article. Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study. Larochelle MR, et al. Ann Intern Med . 2016;164:1–9. Study Objective.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence January–February 2016 www.aodhealth.org

  2. Featured Article Opioid prescribing after nonfatal overdose and association with repeated overdose: a cohort study. Larochelle MR, et al. Ann Intern Med. 2016;164:1–9. www.aodhealth.org

  3. Study Objective • To determine opioid dosage prescribed to patients following a non-fatal overdose and any association with repeat overdose. www.aodhealth.org

  4. Study Design • Retrospective cohort study of 2848 commercially insured adults receiving long-term opioid therapy for non-cancer pain who had a non-fatal opioid overdose between 2000 and 2012. www.aodhealth.org

  5. Assessing Validity of an Article about Prognosis • Are the results valid? • What are the results? • How can I apply the results to patient care? www.aodhealth.org

  6. Are the Results Valid? • Was the sample representative? • Were the subjects sufficiently homogeneous with respect to prognostic risk? • Was follow-up sufficiently complete? • Were objective and unbiased outcome criteria used? www.aodhealth.org

  7. Was the sample representative? All subjects in this study… • were aged 18-64 years • had private health insurance through a large US carrier with customers in all 50 states www.aodhealth.org

  8. Were the subjects sufficiently homogeneous with respect to prognostic risk? • Yes. All patients were prescribed long-term opioid therapy (defined as 3 or more dispensings of opioids at least 21 days apart that lasted at least 12 weeks) • Baseline opioid dosages, expressed as morphine equivalent dosage (MED), were < 50 mg/day (low dose) in 33%, 50–100 mg/day (moderate dose) in 22%, and > 100 mg/day (high dose) in 46%. www.aodhealth.org

  9. Was follow-up sufficiently complete? • Yes. The patients were followed a median duration of 299 days (interquartile range, 123 to 639) after the index overdose. www.aodhealth.org

  10. Were objective and unbiased outcome criteria used? • Yes. • Primary outcome was daily opioid dosage following the index overdose. • Secondary outcomes included repeat opioid overdose and doctor switches. www.aodhealth.org

  11. What Are the Results? • How likely are the outcomes over time? • How precise are the estimates of likelihood? www.aodhealth.org

  12. How likely are the outcomes over time? • After the index overdose, 91% of patients received at least 1 opioid prescription over a median follow-up of 299 days; 69–71% of patients had an active opioid prescription 31–60 days after the index overdose and 1/3 were receiving high doses. www.aodhealth.org

  13. How precise are the estimates of likelihood? • Overall, mean opioid dosage decreased from the pre-overdose (152–164 mg) to post-overdose (111–131 mg) levels. • The 2-year cumulative incidence of repeat overdose was 9% with low dosage, 15% with moderate dosage, and 17% with high dosage. • 30% of patients switched to a new prescriber after the index overdose. www.aodhealth.org

  14. How Can I Apply the Resultsto Patient Care? • Were the study patients and their management similar to those in my practice? • Was follow-up sufficiently long? • Can I use the results in the management of patients in my practice? www.aodhealth.org

  15. Were the study patients similar to those in my practice? • The pool of people from which the cohort was drawn was large, but all had private health insurance, which may limit applicability to the those with public insurance or no insurance. www.aodhealth.org

  16. Was follow-up sufficiently long? • Yes. The patients were followed a median duration of 299 days (interquartile range, 123 to 639) after the index overdose. www.aodhealth.org

  17. Can I use the results in the management of patients in my practice? • Yes. This analysis indicates that the majority of patients with nonfatal opioid overdose continue to receive prescription opioids, often at high dosage, for their chronic non-cancer pain. www.aodhealth.org

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