Opioid dose variability could lead to increased risk of overdose, study suggests

Patients prescribed opioid pain medications whose doses varied over time were 3 times more likely to experience an overdose than patients prescribed stable opioid doses, according to an observational study from Kaiser Permanente published today in JAMA Network Open. The study also showed that patients who discontinued long-term opioid therapy for 3 or more months had half the risk of opioid overdose.

"Our study suggests that safely managing long-term opioid therapy is complex," said Ingrid Binswanger, MD, senior investigator at Kaiser Permanente Institute for Health Research in Colorado and co-author of the study.

"This study suggests going up and down on opioid doses -- also called dose variability -- could present an increased risk of overdose," Dr. Binswanger said. "Through this study, we also found eventually discontinuing opioid therapy may prevent overdoses. With continued studies, we hope to find out how care providers can help patients with their pain without putting them at unnecessary risk due to rapid changes in their dose."

The 12-year study included more than 14,000 Kaiser Permanente members in Colorado who were prescribed long-term opioids. Researchers used electronic health records to track the history of patients to see if they had dose changes and overdoses from opioid pain medications and other opioid drugs.

The research team obtained a follow-up $2 million, 4-year grant from the National Institutes for Health. The study will look at how patients and doctors manage changes in opioid doses, including any long-term risks and benefits of discontinuing opioid pain medications.

"Kaiser Permanente, like many health care organizations across the country, has made significant changes to safely reduce opioid prescriptions for our members," said Jason Glanz, PhD, senior investigator at the Institute for Health Research and co-author on the study.

"This study represents the first of many investigations that we plan to do on the topic," Dr. Glanz said. "Our goal is to help identify the most safe and effective approaches for managing long-term opioid therapy. We want to be able to minimize patients' pain and reduce their risk for overdose."