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Prescription opioids such as morphine, oxycodone, and hydrocodone provide pain relief to patients with chronic pain. However, these drugs also pose safety risks to patients. Opioid use can cause respiratory depression, resulting in overdose or death.

As prescription opioids have been used more extensively for pain control in the past two decades due to changing practice guidelines, overdose deaths surged in both Michigan and the United States. Notably, the majority of opioid-related disabilities and deaths result from patients taking opioids as prescribed, rather than from deliberate abuse or misuse. Furthermore, opioid-related deaths are frequently associated with concurrent use of prescribed antidepressants or benzodiazepines like Valium and Zanax.

Pain control is an essential part of patient care, and opioids are one of the primary pain treatments available. While most opioids are used and prescribed appropriately, a small number of patients receive numerous prescriptions from separate prescribers within a short period of time. This lack of coordination increases patients’ risk of accidental overdose and death. This issue brief analyzes accidental deaths from opioid overdoses in Michigan, uncoordinated opioid prescribing among privately insured Michigan patients in 2013, and policy options to improve safe prescribing in the state.

Key findings include:

• Uncoordinated opioid prescribing is a critical patient safety issue in Michigan, particularly for patients who receive a large volume of opioids from multiple prescribers. It is essential that patients receive appropriate pain control, which may include the use of opioids, but pain treatment should not jeopardize patient safety.
• Accidental overdose deaths involving opioids (including prescription drugs and heroin) increased sixfold in Michigan between 1999 and 2013 (from 81 to 519 deaths). These opioid-related deaths represented 38 percent of all accidental drug deaths in 2013, up from 23 percent in 1999.
• Accidental overdose deaths involving prescription opioids represented 43 percent of total opioid deaths in 2013. The remaining 57 percent of deaths were from heroin, which is noteworthy since some patients first become addicted to prescription drugs and then turn to heroin, the strongest form of opioid.
• In 2013, over 600 privately insured Michigan patients in the study group were defined as having uncoordinated opioid prescriptions (0.3 percent of all patients using prescription opioids). These patients filled at least ten opioid prescriptions from four or more providers within three months. As a result, they ran a higher risk of accidental overdose and death because their providers may not have been aware of all their opioid prescriptions.
• In October 2015, the Michigan Prescription Drug and Opioid Abuse Task Force released its findings and recommendations.

Key recommendations to address these issues include:

• Expanding provider education on safe opioid prescribing;
• Requiring providers to have a bona-fide relationship with patients before prescribing controlled substances;
• Launching a public awareness campaign;
• Increasing access to the lifesaving overdose reversal drug naloxone;
• Exploring the possibility of limiting criminal penalties for people who report or seek medical attention for overdoses; and
• Improving the state’s database of controlled substance prescriptions and increasing its use by providers and pharmacists.

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