The impact of various risk assessment time frames on the performance of opioid overdose forecasting models

Hsien Yen Chang, Lindsey Ferris, Matthew Eisenberg, Noa Krawczyk, Kristin E. Schneider, Klaus Lemke, Thomas M. Richards, Kate Jackson, Vijay D. Murthy, Jonathan P. Weiner, Brendan Saloner

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background:An individual's risk for future opioid overdoses is usually assessed using a 12-month "lookback" period. Given the potential urgency of acting rapidly, we compared the performance of alternative predictive models with risk information from the past 3, 6, 9, and 12 months.Methods:We included 1,014,033 Maryland residents aged 18-80 with at least 1 opioid prescription and no recorded death in 2015. We used 2015 Maryland prescription drug monitoring data to identify risk factors for nonfatal opioid overdoses from hospital discharge records and investigated fatal opioid overdose from medical examiner data in 2016. Prescription drug monitoring program-derived predictors included demographics, payment sources for opioid prescriptions, count of unique opioid prescribers and pharmacies, and quantity and types of opioids and benzodiazepines filled. We estimated a series of logistic regression models that included 3, 6, 9, and 12 months of prescription drug monitoring program data and compared model performance, using bootstrapped C-statistics and associated 95% confidence intervals.Results:For hospital-treated nonfatal overdose, the C-statistic increased from 0.73 for a model including only the fourth quarter to 0.77 for a model with 4 quarters of data. For fatal overdose, the area under the curve increased from 0.80 to 0.83 over the same models. The strongest predictors of overdose were prescription fills for buprenorphine and Medicaid and Medicare as sources of payment.Conclusions:Models predicting opioid overdose using 1 quarter of data were nearly as accurate as models using all 4 quarters. Models with a single quarter may be more timely and easier to identify persons at risk of an opioid overdose.

Original languageEnglish (US)
Pages (from-to)1013-1021
Number of pages9
JournalMedical care
Issue number11
StatePublished - Nov 1 2020


  • opioid overdose
  • predictive risk model
  • prescription drug monitoring program
  • risk assessment period

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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