Opioids are addictive narcotic substances that include both illegal drugs (heroin) and legal prescription medications used to treat pain. Opioids that are commonly prescribed in the United States include hydrocodone (an ingredient in Vicodin [AbbVie], Lortab [UCB], Zohydro [Pernix Ireland Pain Limited], and other brand-name drugs), oxycodone (an ingredient in such brand-name drugs as OxyContin [Purdue Pharma] and Percocet [Endo Pharmaceuticals]), and morphine. The United States currently has an epidemic of prescription opioid misuse, with high and rapidly growing numbers of overdose deaths. Physicians are increasingly being expected to examine patients' opioid prescription histories before prescribing these drugs. In fact, many states have laws requiring that physicians check patients' prescription histories using an online database before prescribing opioids. However, we lack information about the association of opioid use patterns with subsequent overdose to guide physicians examining these histories.

To identify patterns of opioid use related to an increased risk for overdose.

More than 600,000 patients enrolled in Medicare from 2008 to 2012 who did not have a cancer diagnosis. Patients with cancer were excluded because relief of cancer pain is an appropriate and common use of opioids.

The researchers identified several measures of opioid misuse that they thought might increase the risk for overdose on the basis of the quantity prescribed, overlapping prescriptions, use of more than 1 prescriber or pharmacy, and use of out-of-state prescribers or pharmacies. The investigators then used the Medicare data to determine whether patients had any of these patterns over a 6-month period and, if so, whether they had an overdose or died in the following year.

All misuse measures examined had a positive association with subsequent opioid overdose and death. As the quantity of opioids or the number of prescribers or pharmacies increased, so did overdose risk.

The study included only Medicare patients, so its results may not apply to younger patients or those with different or no health insurance.

Before prescribing opioids, physicians should see whether the patient's previous use shows the patterns associated with overdose found in this study.

阿片类药物是令人上瘾的麻醉性物质，包括非法药物（海洛因）和用于治疗疼痛的合法处方药。在美国通常开的阿片类药物包括氢可酮（维可丁[AbbVie]，Lortab [UCB]，Zohydro [Pernix Ireland Pain Limited]和其他商标药物中的成分），羟考酮（该商标中的成分药物包括OxyContin [Purdue Pharma]和Percocet [Endo Pharmaceuticals]）和吗啡。目前，美国滥用处方阿片类药物的流行病十分普遍，过量死亡的人数迅速增加。越来越多地期望医师在开出这些药物之前先检查患者的阿片类药物处方史。实际上，许多州都有法律要求医师检查患者的 在开处方阿片类药物之前，先使用在线数据库查看处方历史。但是，我们缺乏有关阿片类药物使用模式与随后过量服用的关联的信息，无法指导医生检查这些历史。

识别与过量用药风险增加相关的阿片类药物使用方式。

从2008年到2012年，超过600,000名未参加癌症诊断的患者参加了Medicare。排除癌症患者是因为缓解癌症疼痛是阿片类药物的一种适当且普遍的用法。

研究人员确定了几种滥用阿片类药物的措施，他们认为这些措施可能会由于处方数量，处方重叠，使用一种以上处方药或药房以及使用州外处方药或药房而增加服用过量的风险。然后，研究人员使用Medicare数据确定患者在6个月内是否有上述任何一种情况，如果有，则确定他们是否服药过量或在第二年死亡。

检查的所有滥用措施均与随后的阿片类药物过量和死亡呈正相关。随着阿片类药物的数量或处方药或药房数量的增加，用药过量的风险也随之增加。

该研究仅包括Medicare患者，因此其结果可能不适用于年轻患者或那些拥有不同或没有健康保险的患者。

在开处方阿片类药物之前，医生应查看患者先前的使用情况是否显示出与这项研究中发现的过量相关的模式。