Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Aug;16(8):1566-79.
doi: 10.1111/pme.12777. Epub 2015 Jun 5.

Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans' Health Administration Patients

Affiliations
Free PMC article

Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans' Health Administration Patients

Barbara Zedler et al. Pain Med. .
Free PMC article

Abstract

Objective: Develop a risk index to estimate the likelihood of life-threatening respiratory depression or overdose among medical users of prescription opioids.

Subjects, design, and methods: A case-control analysis of administrative health care data from the Veterans' Health Administration identified 1,877,841 patients with a pharmacy record for an opioid prescription between October 1, 2010 and September 30, 2012. Overdose or serious opioid-induced respiratory depression (OSORD) occurred in 817. Ten controls were selected per case (n = 8,170). Items for an OSORD risk index (RIOSORD) were selected through logistic regression modeling, with point values assigned to each predictor. Modeling of risk index scores produced predicted probabilities of OSORD; risk classes were defined by the predicted probability distribution.

Results: Fifteen variables most highly associated with OSORD were retained as items, including mental health disorders and pharmacotherapy; impaired drug metabolism or excretion; pulmonary disorders; specific opioid characteristics; and recent hospital visits. The average predicted probability of experiencing OSORD ranged from 3% in the lowest risk decile to 94% in the highest, with excellent agreement between predicted and observed incidence across risk classes. The model's C-statistic was 0.88 and Hosmer-Lemeshow goodness-of-fit statistic 10.8 (P > 0.05).

Conclusion: RIOSORD performed well in identifying medical users of prescription opioids within the Veterans' Health Administration at elevated risk of overdose or life-threatening respiratory depression, those most likely to benefit from preventive interventions. This novel, clinically practical, risk index is intended to provide clinical decision support for safer pain management. It should be assessed, and refined as necessary, in a more generalizable population, and prospectively evaluated.

Keywords: Index; Opioid; Overdose; Questionnaire; Respiratory Depression; Risk.

Similar articles

See all similar articles

Cited by 31 articles

See all "Cited by" articles

References

    1. Chen LH, Hedegaard H, Warner M. Drug‐Poisoning Deaths Involving Opioid Analgesics: United States, 1999–2011. NCHS Data Brief, No 166. Hyattsville, MD: National Center for Health Statistics; 2014. - PubMed
    1. CDC . Vital signs: Overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep 2011;60(43): 1487–92. - PubMed
    1. CDC. Wide‐ranging OnLine Data for Epidemiologic Research (WONDER); 2014. Available at: http://wonder.cdc.gov/mortSQL.html (Accessed October 7, 2014).
    1. CDC . Vital signs: Risk for overdose from methadone used for pain relief—United States, 1999–2010. MMWR Morb Mort Wkly Rep 2012;61(26):493–7. - PubMed
    1. Boudreau D, Von Korff M, Rutter CM, et al. Trends in long‐term opioid therapy for chronic non‐cancer pain. Pharmacoepidemiol Drug Saf 2009;18(12):1166–75. - PMC - PubMed

MeSH terms

Substances

Feedback