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. 2016 May;31(5):478-85.
doi: 10.1007/s11606-015-3539-4.

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

Susan L Calcaterra  1   2 , Traci E Yamashita  3 , Sung-Joon Min  4 , Angela Keniston  5 , Joseph W Frank  6   7 , Ingrid A Binswanger  6   8
Affiliations

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

Susan L Calcaterra et al. J Gen Intern Med. 2016 May.

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.

Keywords: hospital medicine; pain; substance abuse.

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Conflict of interest statement

The authors disclose no conflicts of interest.

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