Maximum Daily Opioid Doses Increase Mortality Risk

But opioid overdose death risk is not affected by regular or as-needed dosing schedule

TUESDAY, April 5 (HealthDay News) -- Patients prescribed higher daily opioid doses for pain are at increased risk of opioid overdose death, according to a study published in the April 6 issue of the Journal of the American Medical Association.

Amy S.B. Bohnert, Ph.D., from the University of Michigan Medical School in Ann Arbor, and colleagues examined whether maximum prescribed daily opioid doses and dosing schedule ("as needed," regular schedule, or both) were linked to the risk of opioid-related deaths in the United States Veterans Health Administration cohort, from 2004 to 2008. The opioid regimen was assessed in 750 decedents and a sample of 154,684 patients with cancer, chronic pain, acute pain, and substance use disorders.

The investigators found that 0.04 percent of the patients treated with opioids had fatal overdoses. There was a direct relationship between the risk of overdose death and maximum prescribed daily opioid doses. Compared to daily opioid doses of 1 mg to less than 20 mg, daily doses of 100 mg or more were associated with increased risk of opioid overdose death in patients with substance use disorders (adjusted hazard ratio [HR], 4.54; absolute risk difference approximation [ARDA], 0.14 percent), chronic pain (adjusted HR, 7.18; ARDA, 0.25 percent), acute pain (adjusted HR, 6.64; ARDA, 0.23 percent), and cancer (adjusted HR, 11.99; ARDA, 0.45 percent). There was no association between as-needed and regularly scheduled doses and adjusted overdose risk.

"The present study found large HRs in the association of maximum daily dose with risk of death by opioid overdose," the authors write.

One of the study authors disclosed a financial relationship with Purdue Pharma.

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