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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 5/2016

01-05-2016 | Original Research

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

Authors: Susan L. Calcaterra, MD MPH, Traci E. Yamashita, MS, Sung-Joon Min, PhD, Angela Keniston, MSPH, Joseph W. Frank, MD MPH, Ingrid A. Binswanger, MD MPH

Published in: Journal of General Internal Medicine | Issue 5/2016

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ABSTRACT

BACKGROUND

Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use.

OBJECTIVE

We aimed to characterize opioid prescribing at hospital discharge among ‘opioid naïve’ patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge.

DESIGN

This was a retrospective cohort study.

PARTICIPANTS

From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital.

MAIN MEASURE

Chronic opioid use 1 year post discharge.

KEY RESULTS

Twenty-five percent of opioid naïve patients (n = 1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p < 0.001), acute pain (2.7 % versus 1.0 %, p < 0.001), chronic pain at admission (12.1 % versus 3.3 %, p < 0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p < 0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p < 0.001) and mental health disorders (23.9 % versus 31.4 %, p < 0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p < 0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR = 4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR = 2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt.

CONCLUSION

Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.
Appendix
Available only for authorised users
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Metadata
Title
Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use
Authors
Susan L. Calcaterra, MD MPH
Traci E. Yamashita, MS
Sung-Joon Min, PhD
Angela Keniston, MSPH
Joseph W. Frank, MD MPH
Ingrid A. Binswanger, MD MPH
Publication date
01-05-2016
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 5/2016
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-015-3539-4

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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