People who received opioids for the first time while hospitalized had double the risk of continuing to receive opioids for months after discharge, compared with their hospitalized peers who were not given opioids. Findings from a retrospective cohort study are published in Annals of Internal Medicine.
Previous studies have shown that some surgical and medical patients who fill opioid prescriptions immediately after leaving the hospital go on to have chronic opioid use. However, little was known about how and if those patients were being introduced to the opioids while in the hospital.
Researchers at the University of Pittsburgh Graduate School of Public Health and School of Medicine colleagues 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 percent of the admissions, with those patients being given opioids for a little more than two-thirds of their hospital stay, on average. Almost 6 percent of patients receiving opioids during their hospital stay were still being prescribed opioids three months later, compared with 3 percent of those without inpatient opioid use.
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 percent of the time for some conditions.
The authors of an accompanying editorial from Boston Medical Center and Boston University suggest that any interaction between patients and the health care system that may involve pain presents the opportunity for a first opioid prescription and avoiding this first prescription in opioid-naïve patients could be important for reducing incident long-term use and associated harms.
The authors suggest the development of a protocol to pursue nonopioid analgesic use before opioid use during hospitalizations. But if they have to be used, they should be used in the lowest dosage and for the least amount of days possible.