EHR study shows dangers of variability in opioid dosages

Results from a 12-year study involving more than 14,000 Kaiser Permanente members’ electronic health records shows the risk of opioid overdose increases when doses vary over time.

The $2 million, funded by the National Institute on Drug Abuse and conducted by researchers at Kaiser Permanente's Institute for Health Research, was published April 19 in the JAMA Network Open.

The results indicate that remediating the addictive risks of the drugs is not as simple as taking patients off their long-term opioid medication. In fact, the study by the national payer organization shows that it might be better to never have prescribed opioids in the first place, say co-authors Jason Glanz, Ingrid Binswanger, MD and Susan M. Shetterly.

“Although practice guidelines have led to substantial reductions in opioid prescribing across the United States, significant decreases in pharmaceutical opioid overdose have not been documented,” the researchers write. “It is thus possible that unexamined prescribing practices or unintended consequences of prescribing policies are contributing to persistently elevated pharmaceutical opioid overdose rates.”

Patients who are prescribed opioid pain medications with doses that varied over time were three times more likely to overdose than patients who were kept on a stable prescription, according to the study, which looked for opioid use among Kaiser Permanente members by culling their EHRs.

Researchers found that when providers attempted to reduce the opioid prescriptions, patients sought more from other sources—for example, from their friends, not fully understanding the potency of the medication they were taking. Some patients asked for higher doses from their physicians. These scenarios led to overdoses while the patient was being tapered off of a long-term opioid prescription.

By contrast, the study also showed that patients who went off their opioid medication and made it past the three-month mark cut their risk of opioid overdose in half.

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

Glanz, senior investigator at the Institute for Health Research and co-author of the study, said Kaiser Permanente, like many healthcare organizations, has made significant changes to safely reduce opioid prescriptions for its members.

“This study represents the first of many investigations that we plan to do on the topic,” he 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."

The study, entitled, “Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy,” can be accessed here.