A large study published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230459 identified 10 predictors of opioid overdose after prescription for chronic pain, which can help clinicians engage in shared decision-making with patients around opioid prescribing.

"The opioid crisis has generated interest in identifying patients at higher risk of addiction or overdose and has led to the development of several screening tools; however, these instruments have either not been validated or shown poor psychometric properties," writes Dr. Li Wang, a researcher and methodologist at the Michael G. DeGroote Institute for Pain Research and Care, and Department of Anesthesia, McMaster University, Hamilton, Ontario, with coauthors. "Our findings suggest that awareness of, and attention to, several patient and prescription characteristics, may help reduce the risk of opioid overdose among people living with chronic pain."

Researchers looked at 28 studies that included almost 24 million patients in the United States, Canada and the United Kingdom who had been prescribed opioids for non-cancer and cancer-related chronic pain. The risk of fatal and nonfatal opioid overdose after prescription increased two- to six-fold with high-dose opioids, fentanyl prescription, multiple opioid prescribers or pharmacies, history of overdose, current substance use disorder, depression, bipolar disorder, other mental illness or pancreatitis.

"Our findings should prove helpful for conveying risks of overdose to patients when deciding whether to initiate a trial of opioids for chronic pain, and will facilitate evidence-based, shared decision-making," write the authors.