ArticlePharmacoepidemiology and drug safety2019
Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended-release long-acting opioids.
Article in Pharmacoepidemiology and drug safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- Predictors of fatal and nonfatal overdose after prescription of opioids for chronic pain: a systematic review and meta-analysis of observational studies.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Pooled it
- Long-Term Opioid Therapy and Risk of Opioid Overdose by Derived Clinical Indication in North Carolina, 2006-2018.Pharmacoepidemiology and drug safety · 2025Article
- An Exploratory Analysis of Differential Prescribing of High-Risk Opioids by Insurance Type Among Patients Seen by the Same Clinician.Journal of general internal medicine · 2023Article
- Article
- Opioid2MME: Standardizing opioid prescriptions to morphine milligram equivalents from electronic health records.International journal of medical informatics · 2022Article
- Personal experience and awareness of opioid overdose occurrence among peers and willingness to administer naloxone in South Africa: findings from a three-city pilot survey of homeless people who use drugs.Harm reduction journal · 2022Article
- The effect of state policies on rates of high-risk prescribing of an initial opioid analgesic.Drug and alcohol dependence · 2022Article
- Digital Analgesic Comprising a Second-Generation Digital Health System: Increasing Effectiveness by Optimizing the Dosing and Minimizing Side Effects.Journal of pain research · 2022Review
- Initiation of Long-Acting Opioids Following Hospital Discharge Among Medicare Beneficiaries.Journal of hospital medicine · 2021Article
- Assessing opioid overdose risk: a review of clinical prediction models utilizing patient-level data.Translational research : the journal of laboratory and clinical medicine · 2021Review
- New-user and prevalent-user designs and the definition of study time origin in pharmacoepidemiology: A review of reporting practices.Pharmacoepidemiology and drug safety · 2021Review
- Gaps in the Use of Long-Acting Opioids Within Intervals of Consecutive Days Among Cancer Outpatients Using Electronic Pill Caps.Pain medicine (Malden, Mass.) · 2021Observational
- Medical Use of Long-term Extended-release Opioid Analgesics in Commercially Insured Adults in the United States.Pain medicine (Malden, Mass.) · 2020Article
- Tramadol Prescription over a 4-Year Period in the USA.Current pain and headache reports · 2019Review
- Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy.JAMA network open · 2019Article
- The double opioid crisis: A call for balance.Pharmacoepidemiology and drug safety · 2019Article
- The impact of California wildfires on patient access to prescription opioids.Journal of the American Pharmacists Association : JAPhAArticle
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4 authors at 1 institution in 1 country.
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Abstract
backgroundIn recognition of potential for increased overdose risk, drug labels for extended-release and long-acting (ER/LA) opioids emphasize the need for established opioid tolerance prior to initiating high dosages.
objectivesDescribe the proportion of patients with opioid tolerance prior to initiation of 90 morphine milligram equivalents (MME) ER/LA opioids and examine subsequent risk of opioid poisoning.
methodsWe used Truven Health Analytics' MarketScan Databases (2006-2015) to identify patients initiating ER/LA opioids ≥90 MME. We examined prescription histories and describe the proportion of initiators with opioid tolerance (defined as ≥7 days of 60 MME in the prior 14 days). We adjusted for age, sex, year of initiation, and baseline comorbidities using inverse probability of treatment weighted Cox proportional hazards models. We estimated adjusted hazard ratios and 95% confidence intervals for the effect of opioid tolerance on the risk of clinically recognized opioid poisoning (based on diagnosis codes) in specific periods (0-7, 8-30, 31-90, and 91-365 days) following initiation.
resultsAmong 372 038 initiators, 38% did not meet opioid tolerance criteria. The proportion of nontolerant initiators was highest among those initiating methadone (44%) and fentanyl (42%). Nontolerant patients were 37% more likely to be diagnosed with opioid poisoning (adjusted hazard ratios = 1.37 [1.07, 1.76]) in the week following ER/LA initiation.
conclusionsOver one-third of patients initiating ≥90 MME ER/LA opioids did not have evidence of opioid tolerance. The 7 days following high dose ER/LA initiation may represent a high-risk period for clinically diagnosed opioid poisoning in patients who do not have prior opioid tolerance.
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