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Editor's Correspondence |

Opioids and Dose-Related Deaths—Association or Causation?—Reply

Tara Gomes, MHSc; Muhammad M. Mamdani, PharmD, MA, MPH; Irfan A. Dhalla, MD, MSc; J. Michael Paterson, MSc; David N. Juurlink, MD, PhD
Arch Intern Med. 2011;171(18):1687-1689. doi:10.1001/archinternmed.2011.453.
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We believe Dr Williamson has misinterpreted some aspects of the methodology of our study and its findings. Dr Williamson states that an unadjusted analysis reveals no association between higher opioid dose categories and opioid-related mortality. This is incorrect. Although not reported in our published article,1 the association between dose and opioid-related mortality was consistent in our unadjusted conditional logistic regression model for the primary outcome (odds ratio, 2.32, 2.97, and 3.69 among those prescribed 50-99 mg of morphine equivalents per day [ME/d], 100-199 mg of ME/d, and ≥200 mg of ME/d, respectively, compared with the 1-19 mg of ME/d group; P < .001 for all comparisons). Although the 95% confidence intervals overlap between high and moderate dose categories, a clear and significant association between higher doses of opioids and opioid-related mortality is apparent in both unadjusted and adjusted models.

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October 10, 2011
Owen Douglas Williamson, MBBS, FFPMANZCA
Arch Intern Med. 2011;171(18):1687-1689. doi:10.1001/archinternmed.2011.452.
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