Overdose Rates Increased When Pain Meds Prescribed by Multiple Providers

PainRelief.com Interview with:
Kao-Ping Chua, MD, PhD
Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center,
Department of Health Management and Policy, School of Public Health,
University of Michigan Ann Arbor

Dr. Kao-Ping Chua

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Having overlapping opioid and benzodiazepine prescriptions is a strong risk factor for opioid overdose even if these prescriptions are written by the same prescriber.

In this study of privately insured and Medicare Advantage patients, we show that the risk of overdose is even greater when the prescriptions are written by multiple prescribers. Specifically, the unadjusted risk of overdose on a day of overlap was 1.8 times higher when the prescriptions were written by multiple prescribers. After controlling for patient demographic characteristics, clinical co-morbidities, and prescribing patterns, the adjusted odds of overdose was 1.2 times higher, corresponding roughly to a 20% higher adjusted risk.

PainRelief.com: What should readers take away from your report?

Response: In our study, 1 in 231 patients overdosed while they were followed in the study. This highlights the importance of avoiding overlapping opioid and benzodiazepine prescriptions whenever possible. However, when this is not possible, our findings indicate that it is especially important to implement overdose mitigation measures when prescriptions come from multiple prescribers. These measures might include co-prescribing naloxone and counseling patients only to take medications as prescribed.

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: The mechanism of the observed association is unclear. We hypothesize that poor care coordination may play a role. For example, prescribers of benzodiazepines may be unaware that patients are taking opioids or vice versa, thus missing opportunities to implement risk mitigation measures. However, research is needed to evaluate this possibility.

No disclosures.


Chua K, Brummett CM, Ng S, Bohnert ASB. Association Between Receipt of Overlapping Opioid and Benzodiazepine Prescriptions From Multiple Prescribers and Overdose Risk. JAMA Netw Open. 2021;4(8):e2120353. doi:10.1001/jamanetworkopen.2021.20353

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