The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015
https://journals.sagepub.com/doi/abs/10.1177/0033354919878429
Abstract
Objectives:
Opioid-related overdoses are commonly attributed to prescription opioids. We examined data on opioid-related overdose decedents in Massachusetts. For each decedent, we determined which opioid medications had been prescribed and dispensed and which opioids were detected in postmortem medical examiner toxicology specimens.
Methods:
Among opioid-related overdose decedents in Massachusetts during 2013-2015,
we analyzed individually linked postmortem opioid toxicology reports and prescription drug monitoring program records to determine instances of overdose in which a decedent had a prescription active on the date of death for the opioid(s) detected in the toxicology report. We also calculated the proportion of overdoses for which prescribed opioid medications were not detected in decedents’ toxicology reports.
Results:
Of 2916 decedents with complete toxicology reports, 1789 (61.4%) had heroin and 1322 (45.3%) had fentanyl detected in postmortem toxicology reports. Of the 491 (16.8%) decedents with ≥1 opioid prescription active on the date of death, prescribed opioids were commonly not detected in toxicology reports, specifically: buprenorphine (56 of 97; 57.7%), oxycodone (93 of 176; 52.8%), and methadone prescribed for opioid use disorder (36 of 112; 32.1%). Only 39 (1.3%) decedents had an active prescription for each opioid detected in toxicology reports on the date of death.
this study was for a time frame BEFORE the CDC published their opiate dosing guidelines. Legal opiate Rxs PEAKED in 2012 and started declining… so this study period was during a time Rx opiate presribing were declining.
Filed under: General Problems
All physicians realize that opiate medications and synthetic medication has the potential to kill but, I believe that most physicians by far, use all due diligence in prescribing these medications. There is always going to be the potential for diversion, and abuse with prescribed AND illicit substances but, through careful documentation, drug screening through urinalysis, it is reasonably easy to find those that are not using medication responsibly and IF they are not willing to use their prescribed medication responsibly then what? Do we throw them away? Through sanctioning, dot/gov is going to solve the problem? What is next, a “tariff” on the patients medication use, as little as we get now? Further sanctioning? Total denial of medication documented as useful for lifetime AND acute pain? Insanity! Come live in “our” world, those of you who believe that these ,medications are not useful! That we “do not need them” Put yourself in the other persons shoes. No, the “experts, are always “right” or, is it PROFIT motivated? Don’t know.