Rates of opioid administration were found to be high in opioid-naive inpatients, and certain patterns of inpatient opioid use were found to be associated with long-term use of the medication, according to a study published in the Annals of Internal Medicine.

In this 5-year retrospective cohort study, data from the electronic health records of 12 community and academic Pennsylvania hospitals gathered between 2010 and 2014 were analyzed to identify patterns of opioid administration in opioid-naïve patients that may be associated with post-discharge opioid use. The data of patients who had ≥1 outpatient encounter in the 12 months pre- and post-admission were included in the analysis (n=191,249 admissions). End point measures were the numbers of days and patterns of inpatient use of opioids, as well as any outpatient use of opioids (self-reported and prescription orders) at 90 and 365 days post-discharge.

Opioids were administered in 48% of hospital admissions of opioid-naive patients, with a mean of 67.9±25.0% of patients administered opioids during their hospital stay. Inpatient opioid use was associated with an approximately 2-fold higher relative risk for outpatient opioid use within 90 days of hospital discharge (relative risk ratio [RR], 2.07; 95% CI, 1.97-2.18). There were substantial variations in the location of the first administration of opioids after admission, the timing of the last opioid administered before discharge, and the receipt of nonopioid analgesics.

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After adjusting for confounders, 5.9% of inpatients who received opioids had outpatient opioid use 90 days after discharge compared with 3.0% of patients without inpatient use of opioids (difference, 3.0%; 95% CI, 2.8-3.2). The use of opioids at 90 days was higher among inpatients who received opioids less than 12 hours before discharge compared with those who had >24 opioid-free hours before discharge (7.5% vs 3.9%, respectively; difference, 3.6%; 95% CI, 3.3-3.9). For patients using opioids for ≥75% of their length of stay vs ≤25% of their stay, opioid use at 90 days was 6.4% and 5.4%, respectively (difference, 1.0%; 95% CI, 0.4-1.5). Similar patterns were observed for opioid use 365 days post-discharge.

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Stud limitations include the lack of accounting of factors such as pain severity, opioid dosage, or history of substance use disorder, a possible misclassification of some patients as opioid-naive, and the lack of accounting for illegal opioid use.  “This 5-year observational study sheds light on patterns of inpatient opioid administration to opioid-naive patients. Receipt of any opioids in the hospital was associated with nearly twice the probability of continued outpatient use. Our findings also highlight specific patterns of inpatient opioid prescribing that are associated with continued outpatient use and are likely amenable to health system interventions,” concluded the study authors.

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Donohue JM, Kennedy JN, Seymour CW, et al. Patterns of opioid administration among opioid-naive inpatients and associations with postdischarge opioid use: A cohort study [published online June 18, 2019]. Ann Intern Med. doi: 10.7326/M18-2864