Review of: Larochelle MR et al, Drug and Alcohol Depend 2019;204:107537

The epidemic of opioid-related deaths has been declared a public health emergency. Research has already described risk factors—or “touchpoints”—associated with an increased risk of opioid overdose: for example, certain clinical scenarios or incarceration. What’s less clear is the relative risk of overdose death and the potential for averting these deaths at each of the touchpoints.

This retrospective cohort study included over 6 million person-years among Massachusetts residents ages 11 years and older as of January 2014. They were followed for one year or until their month of death. The outcome was fatal opioid overdose. Past 12-month exposure to eight touchpoints was identified. Touchpoints were either related to opioid prescription (high dose, benzodiazepine coprescribing, multiple providers, or multiple pharmacies) or related to a critical encounter (opioid detoxification, nonfatal opioid overdose, injection-related infection, or release from incarceration).

Of 1,315 Massachusetts residents who died from opioid overdose in 2014, 52% had exposure to one of eight touchpoints within the healthcare, criminal justice, or public health system. Specifically, 20.5% of those who had a fatal overdose had an opioid-prescription touchpoint, and 37.3% had a critical-encounter touchpoint. An overdose death was 12.6 times and 68.4 times more likely among individuals who had an opioid-prescription or a critical-encounter touchpoint, respectively, compared to those without any touchpoint.

The researchers concluded that the eight touchpoints were associated with increased risk of fatal opioid overdose and collectively accounted for more than half of the overdose deaths.

CATR’s Take
We should identify and act upon specific risk factors for opioid overdose, especially a history of opioid detoxification, nonfatal overdose, injection-related infection, or release from incarceration. Patients with these risk factors are especially good candidates for outreach efforts and harm reduction strategies, such as overdose education and naloxone distribution.