Table 1.

Clinical Risk Factors of Opioid-Induced Respiratory Depression and Opioid Overdose

Previous Drug Use Disorder

History of substance abuse, dependence, and/or addiction18,19 History or presence of mental illness18,19

Dosing and Switching Medications

Use of extended-release formulations and long-acting opioids19,22,25 Switching to another opioid23 Morphine-equivalent dose ≥20 mg daily22,25,26

Accidental Exposure and Unintentional Opioid Misuse

Member of a household who discovers and uses a prescribed opioid inappropriately23,24 Inadvertently taking more than prescribed, forgetting whether medication was taken, misunderstanding prescribing instructions, cognitive decline causing confusion4

Use of Other Medications

Central nervous system depressants, including benzodiazepines and alcohol20,27 Certain monoamine oxidase inhibitors20 Initiation of CYP3A4 inhibitors (or discontinuation of CYP3A4 inhibitors)20,21

Comorbid Conditions

Chronic pulmonary disease20,22,26,28,29 Sleep apnea22 Asthma20,28,29 Chronic kidney and/or liver impairment20,22,28,29 Pancreatitis22 Traumatic injury22 Skin ulcers22

CYP3A4 indicates cytochrome P450 3A4.