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High-risk prescribing and opioid overdose

prospects for prescription drug monitoring program–based proactive alerts

Geissert, Petera,*; Hallvik, Sarab; Van Otterloo, Joshuac; O'Kane, Nicoleb; Alley, Lindseyb; Carson, Jodyb; Leichtling, Gillianb; Hildebran, Christi IIIb; Wakeland, Waynea; Deyo, Richard A.d

doi: 10.1097/j.pain.0000000000001078
Research Paper
Global Year 2018

To develop a simple, valid model to identify patients at high risk of opioid overdose–related hospitalization and mortality, Oregon prescription drug monitoring program, Vital Records, and Hospital Discharge data were linked to estimate 2 logistic models; a first model that included a broad range of risk factors from the literature and a second simplified model. Receiver operating characteristic curves, sensitivity, and specificity of the models were analyzed. Variables retained in the final model were categories such as older than 35 years, number of prescribers, number of pharmacies, and prescriptions for long-acting opioids, benzodiazepines or sedatives, or carisoprodol. The ability of the model to discriminate between patients who did and did not overdose was reasonably good (area under the receiver operating characteristic curve = 0.82, Nagelkerke R2 = 0.11). The positive predictive value of the model was low. Computationally simple models can identify high-risk patients based on prescription history alone, but improvement of the predictive value of models may require information from outside the prescription drug monitoring program. Patient or prescription features that predict opioid overdose may differ from those that predict diversion.

Computationally simple models can identify high-risk patients from prescription history alone, but improving specificity of models may require information from outside the PDMP.

aDepartment of Systems Science, Portland State University, Portland, OR, USA

bHealthInsight Oregon, Portland, OR, USA

cPrescription Drug Monitoring Program, Oregon Health Authority, Portland, OR, USA

dDepartment of Family Medicine, Oregon Health & Science University, Portland, OR, USA

Corresponding author. Address: Department of Systems Science, Portland State University, 1604 SW 10th Ave, Portland, OR 97201, USA. Tel.: 971-409-6364. E-mail address: (P. Geissert).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received February 21, 2017

Received in revised form August 01, 2017

Accepted September 21, 2017

© 2018 International Association for the Study of Pain
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