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Intervention reduces opioid exposure, improves pain

An intervention that incorporates a standard for opioid prescribing significantly decreases IV opioid exposure in hospitalized patients while improving pain control, according to JAMA Internal Medicine.

“Opioids are commonly used to treat pain in hospitalized patients; however, IV administration carries an increased risk of adverse effects compared with oral administration,” Adam L. Ackerman, MD, from Yale University School of Medicine, and colleagues wrote. “The subcutaneous route is an effective method of opioid delivery with favorable pharmacokinetics.”

Ackerman and colleagues conducted a pilot study to determine whether an inpatient intervention that favors oral and subcutaneous routes rather than IV administration reduces IV opioid use and total parenteral opioid exposure. The intervention provided prescribers and nursing staff with education on opioid routes of administration. The researchers compared opioid use during a 6-month control period with the 3-month period after the education was provided.

The intervention group consisted of 127 hospitalized patients (46.5% men; mean age, 57.6).

There was an 84% reduction in IV opioid doses (0.06 vs. 0.39 doses per patient-day) and 55% reduction in doses of all parenteral opioids (0.18 vs. 0.39 doses per patient-day). Additionally, there was a 49% decrease in mean daily parenteral opioid exposure (2.88 vs. 5.67 morphine-milligram equivalents [MMEs] per patient-day).

There was also a 57% reduction in the daily rate of patients administered any parenteral opioid (6% vs. 14%). Oral or parenteral opioid doses decreased 23% (0.73 vs. 0.95 doses per patient-day), while mean daily overall opioid exposure decreased 31% (6.3 vs. 9.11 MMEs per patient-day).

During the first 3 days of hospitalization, the pain score for patients receiving opioid therapy did not significantly differ between the postintervention and preintervention periods. However, the intervention group showed significant improvement in pain score on days 4 (–1.07; 95% CI, –1.8 to –0.34) and 5 (–1.06; 95% CI, –1.84 to –0.27).

“Adoption of a new standard of inpatient opioid prescribing, preferring the oral route of administration when available and the subcutaneous route when parenteral administration is required, coupled with education of prescribers and nursing staff, was associated with a reduction of inpatient exposure to [IV] opioids with improved pain control,” Ackerman and colleagues concluded. – by Alaina Tedesco

Disclosure: Ackerman and colleagues report no relevant financial disclosures.