One large fair-quality retrospective cohort study (Dunn et al, 2010) found that recent opioid use was associated with increased risk for any overdose events and also associated with serious overdose events when compared to patients not on opioids. This study also found that with higher doses risk increases.
Compared to a patient on opioid doses <20 MME/day, a patient on 20-49 MME/day was at 1.44x increased risk for any overdose event (adjusted hazard ratio (HR) for any overdose event was 1.44), a patient on 50–99 MME/day was at 3.73x increased risk, and a patient on ≥100 MME/day was at 3.73x increased risk. A similar pattern was observed for serious overdose events.
A good-quality population-based, nested case-control study (Gomes et al, 2011) also found a dose-dependent association with risk for overdose death. Relative to <20 MME/day, the adjusted odds ratio (OR) was 1.32 for patients on 20–49 MME/day, 1.92 for 50–99 MME/day, 2.04 for 100–199 MME/day, and 2.88 for ≥200 MME/day.
References:
- Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med 2010; 152:85–92.
- Gomes T, Mamdani MM, Dhalla IA, et al. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med 2011; 171:686–91.
- CDC Calculating Total Daily Dose of Opioids
- McEvoy MD, Scott MJ, Gordon DB, et al. Perioperative Quality Initiative (POQI) I Workgroup.
- American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1-from the preoperative period to PACU. Perioper Med (Lond). 2017 Apr 13; 6:8
- Scott MJ, McEvoy MD, Gordan DB, et al. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: Part 2 – From PACU to the Transition Home. Perioper Med, 2017; Apr 13;6:7