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01-10-2018 | Original Research

Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy

Authors: Jason M. Glanz, PhD, Komal J. Narwaney, PhD, Shane R. Mueller, MSW, Edward M. Gardner, MD, Susan L. Calcaterra, MD, MPH, Stanley Xu, PhD, Kristin Breslin, MPH, Ingrid A. Binswanger, MD, MPH

Published in: Journal of General Internal Medicine | Issue 10/2018

Abstract

Background

Naloxone is a life-saving opioid antagonist. Chronic pain guidelines recommend that physicians co-prescribe naloxone to patients at high risk for opioid overdose. However, clinical tools to efficiently identify patients who could benefit from naloxone are lacking.

Objective

To develop and validate an overdose predictive model which could be used in primary care settings to assess the need for naloxone.

Design

Retrospective cohort.

Setting

Derivation site was an integrated health system in Colorado; validation site was a safety-net health system in Colorado.

Participants

We developed a predictive model in a cohort of 42,828 patients taking chronic opioid therapy and externally validated the model in 10,708 patients.

Main Measures

Potential predictors and outcomes (nonfatal pharmaceutical and heroin overdoses) were extracted from electronic health records. Fatal overdose outcomes were identified from state vital records. To match the approximate shelf-life of naloxone, we used Cox proportional hazards regression to model the 2-year risk of overdose. Calibration and discrimination were assessed.

Key Results

A five-variable predictive model showed good calibration and discrimination (bootstrap-corrected c-statistic = 0.73, 95% confidence interval [CI] 0.69–0.78) in the derivation site, with sensitivity of 66.1% and specificity of 66.6%. In the validation site, the model showed good discrimination (c-statistic = 0.75, 95% CI 0.70–0.80) and less than ideal calibration, with sensitivity and specificity of 82.2% and 49.5%, respectively.

Conclusions

Among patients on chronic opioid therapy, the predictive model identified 66–82% of all subsequent opioid overdoses. This model is an efficient screening tool to identify patients who could benefit from naloxone to prevent overdose deaths. Population differences across the two sites limited calibration in the validation site.

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Title: Prediction Model for Two-Year Risk of Opioid Overdose Among Patients Prescribed Chronic Opioid Therapy
Authors: Jason M. Glanz, PhD
Komal J. Narwaney, PhD
Shane R. Mueller, MSW
Edward M. Gardner, MD
Susan L. Calcaterra, MD, MPH
Stanley Xu, PhD
Kristin Breslin, MPH
Ingrid A. Binswanger, MD, MPH
Publication date: 01-10-2018
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 10/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-017-4288-3

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Abstract

Background

Objective

Design

Setting

Participants

Main Measures

Key Results

Conclusions

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Key Results

Conclusions

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