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J Gen Intern Med. 2015 Aug;30(8):1081-96. doi: 10.1007/s11606-015-3199-4. Epub 2015 Feb 4.

Drug Overdose in a Retrospective Cohort with Non-Cancer Pain Treated with Opioids, Antidepressants, and/or Sedative-Hypnotics: Interactions with Mental Health Disorders.

Author information

1
Division of General Internal Medicine, Department of Medicine, University of Texas Health Science Center San Antonio (UTHSCSA), 7411 John Smith Rd. Suite 1050, San Antonio, TX, 78229, USA, turner@uthscsa.edu.

Abstract

BACKGROUND:

Opioid analgesics and other psychoactive drugs may pose an even greater risk for drug overdose in persons with mental health disorders.

OBJECTIVE:

The purpose of this study was to examine interactions of filled prescriptions for opioids, benzodiazepines, antidepressants, and zolpidem with mental health disorders in regard to drug overdose.

DESIGN:

The study was a retrospective cohort review.

SUBJECTS:

Subjects were national HMO beneficiaries aged 18-64 years, enrolled at least 1 year (01/2009 to 07/2012), who filled at least two prescriptions for Schedule II or III opioids for non-cancer pain.

MAIN MEASURES:

The outcome was the first inpatient or outpatient drug overdose after the first filled opioid prescription. Predictors were calculated in 6-month intervals and exactly 6 months before a drug overdose: opioid use (mean daily morphine-equivalent dose), benzodiazepine use (days' supply), antidepressant use (days' supply), zolpidem use (days' supply), mental health disorders (depression, anxiety/PTSD, psychosis), pain-related conditions, and substance use disorders (alcohol, other drug).

KEY RESULTS:

A total of 1,385 (0.67%) subjects experienced a drug overdose (incidence rate 421/100,000 person-years). The adjusted odds ratios (AOR) for overdose among all subjects rose monotonically with daily opioid dose, but highest (AOR = 7.06) for persons with depression and a high opioid dose (≥100 mg) versus no depression or opioid use. Longer-term antidepressants (91-180 days) were protective for persons with depression, with 20% lower AORs for overdose versus short-term (1-30 days) or none. For persons without depression, the AORs of overdose were increased for antidepressant use, but greatest (AOR = 1.98) for short-term use versus none. The AORs of overdose increased with the duration of benzodiazepine therapy among all subjects, with over 2.5-fold higher AORs for 91-180 days versus none.

CONCLUSIONS:

Opioids and longer-duration benzodiazepines were associated with drug overdose among all subjects, but opioid risk was greatest for persons with depression. Antidepressant use > 90 days reduced the odds of overdose for persons with depression, but all antidepressant use increased the risk for persons without depression.

PMID:
25650263
PMCID:
PMC4510211
DOI:
10.1007/s11606-015-3199-4
[Indexed for MEDLINE]
Free PMC Article

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