R.I. researchers discover prescription opioids behind nearly 68% of nationwide overdose emergency department visits

PROVIDENCE – Researchers from Rhode Island and THe Miriam hospitals and the Stanford University School of Medicine have found that prescription opioids, including methadone, were involved in nearly 68 percent (or more than 135,00 visits) of nationwide emergency department visits in 2010, with the highest proportion of opioid overdoses occurring in the south.

Several concurrent health conditions were identified as common among overdose victims, including chronic respiratory diseases and mental health-mood disorders, researchers found.

The data suggested that opioids should be prescribed with caution to patients with pre-existing medical conditions, they said.

The study and its findings have been published online in JAMA Internal Medicine.

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“Opioid overdose takes a significant toll on the health care system in the United States, both in terms of finances and resources,” Dr. Traci Green, an epidemiologist at the Department of Emergency Medicine at Rhode Island Hospital and a senior researcher on the study, said in a statement. “To date, there have been minimal studies and related national data about opioid overdoses in emergency departments.”

According to the Centers for Disease Control and Prevention, deaths from drug overdoses have been rising steadily over the past two decades. Every day in the United States, 114 people die due to a drug overdose.

Opioid overdose, which includes medications such as oxycodone, hydrocodone and methadone, is the leading cause of accidental death for adults in the United States, researchers said.

Green, who is also affiliated with the Rhode Island Hospital Injury Prevention Center and The Center for Prisoner Health and Human Rights at The Miriam Hospital, and Dr. Josiah Rich, director of the Center for Prisoner Health and Human Rights at The Miriam Hospital, are credited with spearheading a Rhode Island “collaborative practice agreement” which allows anyone to walk into a Rhode Island Walgreens or CVS/pharmacy and obtain naloxone (also known as Narcan) as well as training on how to use it.

Miriam also joined with Rhode Island and Newport hospitals to launch a program to help combat the opioid overdose epidemic, including emergency department-based overdose prevention and response education and distribution of intra-nasal naloxone rescue kits to overdose patients and their families.

The opioid overdose research done by Michael Yokell, a former researcher at Miriam; Green, and their colleagues found that the number of emergency department visits resulting in death was highest for overdoses involving multiple opioids. It was lowest for prescription opioids.

Overall, the death rate was less than 2 percent for patients who made it to the emergency department, highlighting the need to ensure safe access to emergency medical services for overdose victims.

The study was an analysis of the 2010 nationwide emergency department sample.

In addition to prescription opioids’ involvement in 67.8 percent of all overdoses, the findings showed that heroin played a role in 16.1 percent of all overdoses; unspecified opioids were involved in 13.4 percent; and multiple opioid types were involved in 2.7 percent.

“Because most of the patients we studied overdosed on prescription opioids,” Yokell said, “it’s of critical importance that further efforts be made to stem the prescription overdose epidemic.”

According to the R.I. Department of Health, there have been 105 accidental drug overdose deaths since July.

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