High-Risk Use of Prescription Opioids Blamed for Deaths in Tennessee


High-risk drug/medication use is a term that describes a pattern of drug or medication intake that substantially increases the chances that a person will experience a seriously negative substance-related health outcome. In addition to diagnosable abuse or addiction, the most prominent potential negative outcome is overdose. In a study published in March 2014 in the American Medical Association journal JAMA Internal Medicine, researchers from several U.S. institutions assessed the extent to which involvement in high-risk use of an opioid pain medication increases the likelihood that any given individual will experience an opioid overdose.

All opioid drugs and medications share common roots in certain chemicals found in the opium poppy. When they enter the body in any significant amount, all opioid substances travel through the bloodstream, reduce the brain’s ability to feel pain signals, increase the brain’s output of pleasure-producing chemicals and generally slow the pace of communication between the nerve cells that make up both the brain and the spinal cord. The pain-disrupting effects of opioids make opioid medications highly useful as treatments for certain forms of moderate and severe pain. The pleasure-producing effects of opioids set the basic conditions for ongoing, repeated use/abuse and the eventual onset of the brain changes that support both opioid dependence and opioid addiction. The ability of opioids to significantly reduce nerve cell communication in the brain and spinal cord open up users of these substances to the possibility of an opioid overdose.

High-Risk Use

In order to limit the risks for abuse, addiction and overdose, doctors typically restrict the amount of opioid painkiller they prescribe to any given patient. They also monitor their patients for any signs that might indicate a potential for the onset of serious opioid-related harm. Several behaviors can significantly increase the odds that a prescription opioid user will experience either a fatal or nonfatal opioid overdose. They include attempting to improperly obtain opioid medications from more than one pharmacy, attempting to improperly obtain opioid medications from more than one prescribing doctor and consuming an unusually high total amount of opioids during any given time period. Public health officials use a standard measurement called morphine milligram equivalents (MMEs) to track overall opioid intake in any user of opioid drugs or medications.

Impact of High-Risk Behavior

In the study published in JAMA Internal Medicine, researchers from the Centers for Disease Control and Prevention, the Tennessee Department of Health and three other institutions used several years of data from a project called the Tennessee Controlled Substances Monitoring Program to analyze the connection between high-risk intake of prescription opioids and the chance of dying from a fatal opioid overdose. They undertook their work, in part, in response to a steep increase in deadly opioid-related overdoses in Tennessee that began in 2003.

After reviewing the compiled data, the researchers found that the rate of opioid prescribing rose significantly in Tennessee during the study’s time frame (2007 through 2011). They also found that, in 2011, 7.6 percent of the prescription opioid users in the state qualified as high-risk by receiving opioids from five or more prescribing doctors. Another 2.5 percent of prescription opioid users qualified as high-risk by picking up their prescribed medications from five or more separate pharmacies, while 2.8 percent qualified as high-risk by consuming a daily average of more than 100 morphine milligram equivalents over a year’s time. The researchers concluded that a prescription opioid user has clearly increased odds of dying from an opioid overdose if he or she participates in any of these behaviors.

Some of the participants enrolled in the study published in JAMA Internal Medicine were involved in only one form of high-risk prescription opioid use, while others were involved in two or three. All told, over half (55 percent) of the fatal overdoses in the state during the study period took place among the small percentage of people affected by at least one of the indicated risk factors. The study’s authors believe that public health officials could help substantially reduce the overall rate of opioid overdose-related fatalities by using the information on high-risk populations to help individuals in those populations with specifically targeted campaigns and interventions. On a side note, since the study only included people in Tennessee, it does not necessarily reflect larger trends in high-risk prescription opioid use in other parts of the U.S.


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