Opioid prescriptions common after hospital discharge

1. Based on retrospective Medicare beneficiary data, about fifteen percent of patients on general medical or surgical wards who were not previously on any opioid medications were discharged with a short-course of opioids. However, almost half of these patients still filled opioid prescriptions 90-days after that initial hospitalization.

2. Hospitals that scored higher on the pain-related performance as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) were slightly associated with more opioid prescriptions at discharge, however the absolute increase was not clinically significant.

Evidence Rating Level: 2 (Good)

Study Rundown: Opioid prescription for pain control after acute hospitalizations may contribute to long-term physiologic tolerance and addiction. It is important to understand how opioids are used and prescribed at hospital discharge, especially from general medical and surgical wards where long-term opioids are general not indicated. This retrospective analysis aimed to estimate the frequency of new opioid prescriptions at hospital discharge, patient and hospital factors associated with it, and long-term prescribing outcomes.

About 15% of hospitalizations were associated with a new opioid claim within seven days of discharge, however almost half of these patients filled an opioid prescription more than 90-days post-discharge. Patient factors associated with new post-discharge opioid use were younger age, living in rural areas, recipients of low-income subsidies, or surgery-related hospitalization. Hospitals that scored higher on the pain-related performance as measured through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) were slightly associated with more opioid prescriptions at discharge, however the absolute increase was not clinically significant. Strengths of the study included the large cohort studied. Limitations of this study included no study of indications of these prescriptions or adverse events.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Long-term analgesic use after low-risk surgery: A retrospective cohort study

In-Depth [retrospective cohort study]: This retrospective study analyzed the pharmacy claims of a random sample of Medicare beneficiaries hospitalized in 2011 in general medical and surgical wards. These patients must not have had an opioid prescription claim in the previous 60 days before hospitalization. The main outcome of interest was whether a beneficiary filled a prescription for a new opioid within 7 days of hospital discharge. Secondary outcomes included: identifying discharges where patients filled an opioid after 90 days of discharge. Multivariable regression was used for statistical analysis.

Of 623 957 hospitalizations over 2011, 14.9% (n = 92 882) were associated with a new opioid claim. There were 77 092 hospitalizations associated with an opioid claim within 7 days of hospital discharge; 32 731 (42.5%) of those hospitalizations were associated with an opioid claim after 90 days post-discharge. Patient factors associated with new post-discharge opioid use were younger age, living in rural areas, recipients of low-income subsidies, or had a surgical hospitalization. A hospital’s rate of new opioid use was associated with the percentage of patients that reported well-controlled pain, with an absolute increase in opioid prescriptions associated with this of 0.89%.

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