![[ Visit Client Website ]](images/banner.jpg)
Prescription drug overdose death has reached epidemic levels in the US over the past 20 years. New Mexico currently has the highest drug overdose death rate in the nation. In developing a process for the systematic review of prescription monitoring data, there is a need to identify problem prescribing and usage practices and quantify the risks involved. A number of usage patterns have been identified as problematic, including high doses of opioids and the use of opioids in combination with benzodiazepines. There is a need to demonstrate the relationships of these patterns to overdose deaths and to set appropriate thresholds for reporting. Comparing results among patients who received various combinations provides a more powerful analysis than comparing the much smaller number of prescribers.
METHODS:
Overdose death data where obtained from the NM Office of the Medical Investigator for 2006-2011 (N=2,900) and linked to 1.57 million individuals in the NM prescription monitoring data for the same period. Linkage was done using name and the date of birth. Drug overdose death rates among persons with “problem prescribing” patterns were compared to rates among persons with controlled substance prescriptions but no identified problem patterns. Comparisons were made via odds ratios and rate ratios for prescription drug overdose deaths and all overdose deaths. Patterns investigated included relatively high doses of opioids, the combination of opioids and benzodiazepines, the combination of opioids, benzodiazepines and carisoprodol (soma) and evidence of prescriber and pharmacy shopping on the part of the patient.
RESULTS:
1,814 overdose deaths (62.6%) matched to controlled substance prescription records within one year of the date of death. Of these, 1,183 were judged by the medical investigator to be prescription drug overdose deaths and 631 to be illicit drug overdose deaths. Patients without any of the problem prescribing patterns under investigation had a prescription drug overdose rate of 27 per 100,000. For those patterns, rates per 100,000 ranged from 334 per 100,000 for those with a history of opioid prescriptions of over 120 MME per day to 4,778 per 100,000 for those who had filled prescriptions from 15 or more prescribers and pharmacies (the sum of the prescriber and pharmacy counts).
CONCLUSIONS:
There are substantial differences in overdose risk by prescribing pattern. This approach shows promise as a technique for setting non-arbitrary thresholds to define “high” doses and doctor shopping.