Based on insurance claims data, this study measured the prevalence of opioid tolerance in patients initiating opioid regimens that require prior tolerance for safe use (such as transmucosal immediate-release fentanyl products). Less than half (48%) of episodes of treatment with an “opioid tolerant only” product occurred among patients with prior evidence of opioid tolerance in the claims data. Less than 1% of these episodes identified from prescription drug claims had evidence of opioid tolerance in structured electronic health records data but not claims data. Patients without opioid tolerance who are prescribed medications that are intended only for opioid-tolerant patients may be at increased risk of harms, including fatal overdose.

Reducing opioid-related harm is a major patient safety priority. This simulation study used a mathematical model to predict the effect of existing opioid misuse interventions on opioid overdose mortality. The researchers compared the expected decline based on the current trend over time versus the effect of a 50% faster reduction in misuse. Their calculations suggest that interventions such as prescription drug monitoring programs and insurance coverage changes will result in only a small absolute decrease in opioid overdose deaths. The authors call for developing and testing other strategies for opioid safety. An Annual Perspective discussed the extent of harm associated with opioid prescribing and described promising practices to address opioid misuse.

High-risk opioid prescribing practices contribute to increased opioid use and opioid-related harm. In this cohort study, researchers found that potentially inappropriate opioid prescribing was associated with increased risk of all-cause mortality and both fatal and nonfatal overdose.

Nationally, opioid overdose remains a common cause of preventable death. Treatment of opioid use disorder with opioid replacement therapy, specifically methadone or buprenorphine, is a potent but underutilized strategy for reducing opioid-related harm. Investigators employed a prospective cohort study to follow 17,568 adults who were treated in Massachusetts emergency departments for a nonfatal opioid overdose. About 15% received opioid replacement therapy in the subsequent 2 years. Patients on opioid replacement therapy were substantially less likely to die from opioids or any other cause. An accompanying editorial from leaders at the National Institute on Drug Abuse highlights strategies to increase the number of Americans offered these life-saving therapies. The editorial also notes the alarming number of patients who received prescriptions for short-acting opioids and benzodiazepines after an opioid overdose. A past Annual Perspective and PSNet perspective delineated other strategies for addressing the opioid crisis.

The opioid epidemic is a well-recognized national patient safety issue. High-risk opioid prescribing can contribute to misuse. Provider prescribing has come under increased scrutiny and several states have implemented prescription drug monitoring programs (PDMPs). Prior research suggests that such programs have the potential to reduce opioid-related harm. This study used commercial claims data to assess the impact of PDMPs implemented in four states in 2012–2013 on opioid prescribing. By the end of 2014, all four states with PDMPs demonstrated a greater reduction in the average amount of morphine-equivalents prescribed per person per quarter compared with states without these programs. One state demonstrated a decrease in the percentage of people who filled an opioid prescription. The authors conclude that PDMPs have the potential to reduce opioid use and improve prescribing practices. An Annual Perspective highlighted safety issues associated with opioid medications.

Patients prescribed opioids and benzodiazepines concurrently may be at increased risk for adverse drug events. Researchers used data from both the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to identify adults already using a benzodiazepine who were newly prescribed opioid medication between 2005 and 2015. Rates of opioid prescribing among patients using a benzodiazepine remained higher than rates in the general population during the entire study period.

Insufficient medication counseling and suboptimal prescribing practices contribute to misuse of opioids among patients. Describing a patient who became addicted to prescription opioids as a teenager after finding the medication at home, this commentary illustrates how current prescribing guidelines can address the opioid epidemic in the United States.

… Ann. Intern. Med. … Ann Inter Med. … Opioid medications are a known safety hazard, and overdoses of opioid medications … treatment patterns for patients who had experienced a nonfatal opioid overdose. More than 90% of patients were … given this crisis in medication safety. A previous WebM&M commentary discussed the challenges of prescribing safely …