Inappropriate Use of High-Potency Opioids Fueling the Opioid Epidemic

Research has shown that widespread opioid overprescribing has contributed to the current opioid epidemic. Now a new study reveals that this dangerous trend of overprescribing has apparently been coupled with another: inappropriate use of high-potency opioids. The cohort study, published April 15 in JAMA Network Open, found that more than half of patients initiating opioid-tolerant only (OTO) medications did not show evidence of prior opioid tolerance

To determine whether OTO medications—including high-dose, extended-release oxycodone; all doses of extended-release hydromorphone; fentanyl patches; and all varieties of transmucosal fentanyl—were inappropriately used across the US, researchers examined pharmacy and medical claims data from 2007 to 2016 from a national database of deidentified longitudinal health information

Of the 153,385 instances of new outpatient prescriptions of these reserved medications that the researchers identified, less than half of the individuals showed evidence of prior opioid tolerance. That suggests that many people starting to use these drugs may be at risk for serious outcomes, including fatal overdose.

The researchers note that they were unable to assess what motivated clinicians to prescribe OTO medications to individuals without evidence of opioid tolerance, but they propose several possible reasons including insufficient training on pain management and lack of familiarity with product labeling requirements.