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Inpatient opioid use doubles odds of outpatient use

Patients prescribed opioids in the hospital were twice as likely to receive an outpatient opioid prescription within 90 days of leaving the hospital, according to findings presented at the American Thoracic Society International Conference.

“Most previous studies of opioid use in health care have focused on the outpatient setting,” Jason Kennedy, MS, from the department of critical care medicine at the University of Pittsburgh, said in a press release. “But opioids are often introduced during hospitalization. That’s something clinicians can control, so we looked at inpatient prescription of these drugs to identify targets that may reduce opioid use once patients are out of the hospital.”

Kennedy and colleagues examined the electronic health records of 192,240 nonobstetrical, opioid-naive adults who were hospitalized between 2010 and 2014 at one of 12 University of Pittsburgh Medical Center hospitals. The researchers defined opioid-naive as not receiving an opioid in the 12 months before hospitalization.

Data showed that 48% of the study population received an opioid during hospitalization. These patients had a more than twofold increased likelihood of outpatient opioid use within 90 days of hospital discharge (8.4% vs. 4.1%).

Patients who received an opioid in the hospital for a long duration (more than 75% of their stay) had a 32% increased chance of continuing use during the 90 days after discharge compared with those who received an opioid in the hospital for a short period of time (less than 25% of their stay). Additionally, patients who received an opioid within 12 hours of discharge were twice as likely to receive an opioid within 90 days of discharge than those who discontinued use more than 24 hours prior to discharge.

Overall, one-third of patients received an opioid within the 24 hours before discharge. The researchers found that opioids were more frequently prescribed in surgical settings than medical (64% vs. 42%). Older patients as well as those who had previously used benzodiazepines or had comorbid behavioral health and pain conditions were more likely to be prescribed opioids in the hospital.

“Reducing use of opiates near the end of a hospital stay, especially in the 24 hours before discharge, may reduce outpatient prescription of opioids,” Kennedy said. “And weaning ICU patients off of intravenous opioids, the most potent way of administering these pain killers, before transitioning them to the medical ward may also help reduce outpatient usage.” – by Alaina Tedesco

Reference:

Kennedy J, et al. Patterns of inpatient, intensive care, and post-discharge opioid prescribing to opioid-naïve patients in a large health system. Presented at: American Thoracic Society International Conference. May 18-23, 2018; San Diego.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.