Dr. Julie Donohue, Ph.D. Professor, Department of Health Policy and Management Vice Chair for Research Graduate School of Public Health University of Pittsburgh

Opioids During Hospitalization Linked to Post-Discharge Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Julie Donohue, Ph.D. Professor, Department of Health Policy and Management Vice Chair for Research Graduate School of Public Health University of Pittsburgh

Dr. Donohue

Dr. Julie Donohue, Ph.D.
Professor, Department of Health Policy and Management
Vice Chair for Research
Graduate School of Public Health
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: The opioid epidemic is exacting a significant burden on families, communities and health systems across the U.S. Prescription and illicit opioids are responsible for the highest drug overdose mortality rates ever recorded. We know from previous studies that some surgical and medical patients who fill opioid prescriptions immediately after leaving the hospital go on to have chronic opioid use. Until our study, however, little was known about how and if those patients were being introduced to the opioids while in the hospital.

My colleagues and I reviewed the electronic health records of 191,249 hospital admissions of patients who had not been prescribed opioids in the prior year and were admitted to a community or academic hospital in Pennsylvania between 2010 and 2014. Opioids were prescribed in 48% of the admissions, with those patients being given opioids for a little more than two-thirds of their hospital stay, on average.

MedicalResearch.com: What are the main findings?

Response: We found that these patients who were given opioids while hospitalized had double the risk of continuing to receive opioids for months after discharge compared with their hospitalized peers who are not given opioids. Specifically, almost 6% of patients receiving opioids during their hospital stay were still being prescribed opioids three months later, compared with 3% of those without inpatient opioid use. And 7.5% of patients who received opioids less than 12 hours before discharge were still receiving opioids 90 days later, compared with 3.9% of their peers who were free of opioids for at least 24 hours prior to discharge.

Additionally, non-opioid painkillers and anti-inflammatory medications, such as ibuprofen, aspirin or naproxen, were rarely tried before an opioid was administered—as little as 7.9% of the time for some conditions. 

MedicalResearch.com: What should readers take away from your report?

Response: The level of opioid prescribing to patients without a history of opioid use is surprising, as was the stability of this prescribing. Nationally and regionally, as people have become more aware of how addictive opioids can be, we’ve seen declines in outpatient opioid prescribing. But we didn’t see that in inpatient prescribing.

While our study could not assess the appropriateness of opioid administration, we identified several practices—low use of non-opioid painkillers, continuous use of opioids while hospitalized, opioid use shortly before discharge—which may be opportunities to reduce risk of outpatient opioid use. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Interventions should be designed and tested to see if it is possible to reduce introduction of opioids to hospitalized patients without compromising care and, for those who need opioids while hospitalized, to lessen their likelihood of chronic use after discharge. For example, perhaps there are ways to increase the use of non-opioid painkillers before trying opioids, avoid continuous use of opioids while hospitalized and take patients off opioids at least 24 hours before discharge. 

Is there anything else you would like to add?

Derek Angus, M.D., M.P.H., chair of Pitt’s Department of Critical Care Medicine, is senior author on this research. Additional authors are Jason Kennedy, M.S., Christopher Seymour, M.D. M.Sc., Timothy Girard, M.D., M.S.C.I ., Oscar Marroquin, M.D., F.A.C.C., and Chung-Chou H. Chang, Ph.D., all of Pitt; Wei-Hsuan Lo-Ciganic, Ph.D., M.S.Pharm., of the University of Florida; Catherine H. Kim, Pharm.D., of UPMC; and Patience Moyo, Ph.D., of Brown University.

 

Citation:

Patterns of Opioid Administration Among Opioid-Naive Inpatients and Associations With Postdischarge Opioid UseA Cohort Study

Ann Intern Med. 2019.
DOI: 10.7326/M18-2864

 

 

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Jun 18, 2019 @ 12:11 pm

 

 

 

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