Prince’s Fentanyl Overdose Should Prompt Us to Ask “Where Does Opioid Use Begin?”

Prince’s Fentanyl Overdose Should Prompt Us to Ask “Where Does Opioid Use Begin?”

One of the great musicians of our age is dead – fentanyl is to blame – Prince’s could have been from preventable … these are the sentiments that are enough for public outrage to point to fentanyl as the ultimate killer and call for tighter, more stringent control of opioids and their prescription.

Forgotten in this discussion which brings together Prince, fentanyl, and death and the subsequent knee-jerk reaction to restrict the use of opioids is the vital role that opioids play in the management of pain, such as during surgery or to relieve chronic pain. The use of opioids often begins in the doctor’s office or as a result of a medical procedure.

Prince - source:
Prince – source:

In an analysis of Medicare beneficiaries, Anupam B. Jena, MD, PhD of Harvard Medical School and her colleagues analyzed 623,957 hospitalizations and associated pharmacy claims to understand the frequency of opioid prescribing after hospital discharge. They found that, after discharge from hospital, 14.9% of patients (n=92,882) had filled a new opioid claim within seven days of discharge. In addition, 90 days after discharge, of the 14.9% of patients (n=92,882), 42.5% (n=32,731) were associated with an opioid claim. This means that more than 6% of all of Medicare beneficiaries were still using opioids 90 days after hospital discharge.

So, what happens after those 90 days?

A recent survey may provide some answers. Alene Kennedy-Hendricks, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, and her coauthors surveyed U.S. adults with recent opioid medication use and asked questions about how they shared, stored and disposed of their opioids. The survey was completed with 1,032 opioid users, who were eligible based on their past-year use of opioid medications. They found that among the survey respondents:

  • 7% shared opioid medication.
  • 6% kept the medication in a locked location.
  • 3% had leftover opioid medication for future use even though they were no longer using the medication.
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These two recent analyses suggest that the opioid problem starts in the doctor’s office or as a result of a medical procedure – i.e. the more than 6% of Medicare beneficiaries who filled their opioid prescription 90 days after hospital discharge. Moreover, the sharing of opioid prescriptions and their inadequate storage and disposal may fuel the opioid “crisis”.

What do you think?

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