Escalating opioid dose is associated with mortality: A comparison of patients with and without opioid use disorder.

Prescription Drug Monitoring Programs (PDMPs) are intended to help reduce prescription drug misuse and opioid overdose, yet little is known about the longitudinal patterns of opioid prescribing that may be associated with mortality. This study investigated longitudinal opioid prescribing patterns among patients with opioid use disorder (OUD) and without OUD in relation to mortality using PDMP data.

Growth modeling was used to examine opioid prescription data from the California PDMP for a 4-year period before death or a comparable period ending in 2014 for those remaining from a sample of 7728 patients (2576 with OUD, and 5152 matched non-OUD controls) treated in a large healthcare system.

Compared to controls, individuals with OUD (alive and deceased) had received significantly more opioid prescriptions, greater number of days’ supply, and steeper increases of opioid dosages over time. For morphine equivalents (ME, in grams) the interaction of OUD and mortality was significant at both intercept and slope; deceased OUD patients demonstrated the sharpest increase (an average yearly increment of 7.84 grams over alive patients without OUD) and ended with the highest level of opioids prescribed before they died (20.2 grams higher). Older age, public health insurance, cancer, and chronic pain were associated with higher number and dose of opioid prescriptions.

Conclusions: Prescription Drug Monitoring Programs offer important resources useful for monitoring physician and patient behaviors to determine potentially unsafe prescription and usage patterns. The database can also be used to identify patients at risk for misuse and related adverse consequences based on prescriptions received for opioids and other drugs. In addition to high levels of opioid prescriptions, clinicians need to pay special attention to escalating patterns of prescription dosage, which can be a critical warning signal for heightened mortality risks, particularly among OUD patients.