Who Is Most at Risk for Opioid Death and How to Help Them: Columbia Research

Just over 60 percent of individuals who died from an opioid overdose had been diagnosed with a chronic pain condition, and many had been diagnosed with a psychiatric disorder, a study of more than 13,000 overdose deaths has found.

Only four percent had been diagnosed as having an abuse problem right before their death.

According to the researchers at Columbia University Medical Center (CUMC), their study is the first to determine the proportion of those who died of an opioid overdose with chronic pain. The findings were published online this week in the American Journal of Psychiatry. The Columbia University study is titled, “Service Use Preceding Opioid-Related Fatality.”

According to the U.S. Centers for Disease Control, the number of opioid-related deaths has quadrupled, from 8,048 in 1999 to 33,091 in 2015.

The Columbia researchers analyzed clinical diagnoses and filled medication prescriptions between 2001 and 2007 for more than 13,000 adults in the Medicaid program who died of an opioid overdose. During the last year of life, more than half of these individuals had been diagnosed with chronic pain. Many had also been diagnosed with depression and anxiety.

“The frequent occurrence of treated chronic pain and mental health conditions among overdose decedents underscores the importance of offering substance use treatment services in clinics that treat patients with chronic pain and mental health problems. Such a strategy might increase early clinical intervention in patients who are at high risk for fatal opioid overdose,” said Mark Olfson, MD, professor of psychiatry at CUMC and lead investigator of the study.

Approximately one-third of those who died had been diagnosed with a drug use disorder in the prior year. However, fewer than one in 20 had been diagnosed with opioid use disorder in the last month.

“Because clinical diagnoses generally indicate treatment, this service pattern suggests that dropout from drug treatment is common before fatal opioid overdose. Improving treatment retention with contingency management or other effective behavioral interventions might help lower the risk of fatal overdose in these patients,” said Dr. Olfson.

In the year before death, more than half had filled prescriptions for opioids or for anti-anxiety medications called benzodiazepines, and many had filled prescriptions for both types of medications.

“This medication combination is known to increase the risk of respiratory depression, which is the unusually slow and shallow breathing that is the primary cause of death in most fatal opioid overdoses,” said Dr. Olfson, noting that the data from the current study were collected between 2001 and 2007. “In the years since, there has been an increase in the proportion of U.S. overdose deaths involving benzodiazepines and opioids.” The authors urged providers to restrict the combination, in the lowest possible dose and duration, to those patients for whom alternative strategies have proven inadequate.

In addition to Dr. Olfson, other contributors to the CUMC study were Melanie Wall (CUMC), Shuai Wang (CUMC), Stephen Crystal (Rutgers, the State University of New Jersey, New Brunswick, N.J.), and Carlos Blanco (National Institute on Drug Abuse, Rockville, Md.). The study was funded by the Agency for Healthcare Research and Quality (U19 HS021112), the National Institute on Drug Abuse (R01 DA019606), and the New York Psychiatric Institute.

Opioids were involved in more than 33,000 deaths in 2015 and opioid overdoses have quadrupled since 1999, according to the Centers for Disease Control and Prevention.

Emergency Room Data

Another recent study found that opioid-related emergency room visits have been increasing since 2013 and in the second quarter of this year, one out of every six was opioid-related.

The study was by OM1, a Boston healthcare data company that used big data analytics to create a prototype for tracking the opioid crisis in near real-time.

OM1 also found while the rate of opioid related emergency room visits has increased across all ages since 2013, the opioid epidemic is disproportionately impacting younger individuals. The fastest growing age segment is the 0-19 year age group, where rates increased from 10 percent in 2013 to 16 percent in Q1 of 2017.

The OM1 opioid tracker shows that the opioid epidemic is not an urban disease. While rates increased in all states, Montana is among a few states with the biggest changes in the proportion of opioid-related ER Visits since 2013.

“The opioid epidemic has reached alarming levels in the U.S., affecting the lives of millions of individuals and families. Big data analytics provide an enormous opportunity to be able to track and evaluate the crisis in near real time,” said Vandana Menon, vice president of Research at OM1.

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