Study: Opioid Users Don’t See Overdose as Wakeup Call

Brush with death had little effect on subsequent use

https://www.medpagetoday.com/PublicHealthPolicy/by-the-numbers/67454

Turns out, even a close call with an overdose isn’t enough to deter opioid users.

As described in a JAMA research letter, Julie M. Donohue, PhD, of the University of Pittsburgh, and colleagues looked at five years of claims data for Medicaid-covered patients in Pennsylvania. They examined records of opioid use both before and after the overdose for 6,000 patients with continuous coverage. About a third of those patients had overdosed on heroin, while the rest overdosed on prescription drugs.

Both heroin and prescription overdosers saw a slight reduction in use, at least as measured by filled prescriptions. Filled opioid prescriptions fell from 43.2% before a heroin overdose to 39.7% afterward. Prescription overdosers, meanwhile, fell from 66.1% to 59.6%.

Along the same lines, rates of medication-assisted treatment such as buprenorphine or methadone similarly increased after an overdose, but not by much.

The slight changes in behavior represented a failed opportunity by the medical community, the authors wrote.

“Despite receiving medical attention for an overdose, these patients in Pennsylvania Medicaid continued to have persistently high prescription opioid use, with only slight increases in MAT engagement, signaling a relatively weak health system response to a life-threatening event,” they wrote.

Intervention has been shown to reduce overdose risk, and studies of commercially-insured patients found the potential intervention opportunities represented by overdoses are underutilized. The research letter found evidence of similar underutilization among Medicaid patients, who are three times as likely as their commercially-insured counterparts to have an overdose in the first place.

The authors acknowledged that the results may be specific to Pennsylvania, and that filled prescriptions were an imperfect measure of continued opioid use. Further, focusing on overdoses that required medical attention probably underestimated the number of overdoses and patients affected.