Inpatient opioids tied to doubled risk for at-home use

  • Donohue JM & al.
  • Ann Intern Med
  • 18 Jun 2019

  • International Clinical Digest
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Takeaway

  • Opioids were given to nearly half of opioid-naive patients during their hospital stay, and were rarely preceded by nonopioid analgesics.
  • Any inpatient opioid use nearly doubled the risk for outpatient use, and patients who received opioids within 12 hours of discharge were more likely to be using opioids 90 days later.

Why this matters

  • An accompanying editorial suggests the findings add weight to the theory that opioid prescribing is "sticky," and that avoiding opioid prescriptions in opioid-naive patients may decrease the risk for chronic use.

Study design

  • Study of 148,068 opioid-naive patients (age, ≥18 years) who visited an emergency department during 2010-2014.
  • Funding: UPMC Health System; University of Pittsburgh.

Key results

  • 48.3% of opioid-naive patients received ≥1 opioid dose during the hospital stay.
  • Nonopioid analgesics were rarely used before opioids (7.9%-22.2%, depending on admission type).
  • Risk for opioid use within 90 days of discharge was 2-fold higher in:
    • Patients with inpatient opioid use (relative risk ratio [RRR], 2.07; 95% CI, 1.97-2.18) vs no outpatient use, death, or readmission.
    • Patients who received an opioid within 12 hours of discharge vs those without opioid use during last 24 hours before discharge (RRR, 2.02; 95% CI, 1.83-2.23).

Limitations

  • Retrospective design.

Coauthored with Antara Ghosh, PhD

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