UWA Discipline of Anaesthesiology and Pain Medicine, Medical School, University of Western Australia, Level 4 MRF Building of RPH, GPO Box X2213, Perth, WA, 6847, Australia.
Drugs. 2020 Apr;80(6):573-585. doi: 10.1007/s40265-020-01294-z.
Mounting evidence highlights the adverse effects of opioids. In spite of this, clinicians often prescribe excessive number of discharge opioids. The aim of this systematic review is to analyse the potential of harm from discharge opioids after inpatient care including excessive prescribing of discharge opioids, improper handling of unused opioids, and unintentional chronic opioid use.
A systematic search of MEDLINE, EMBASE, and Cochrane databases at the cut-off date of 1 December 2018 was conducted for studies reporting on various harmful effects of discharge opioids after inpatient care.
Twenty-eight studies analysed the potential for harm of discharge opioids after various inpatient surgical or medical procedures. On average, patients consumed only 38% of the prescribed discharge opioid pills. Seventy-two percent of patients stored their leftover opioids in an unlocked location, and failure to dispose of unused opioids was reported in 94.5% of patients. These factors may contribute to the increasing rate of opioid misuse and diversion in the community. In addition, discharge opioids contribute to prolonged opioid use; the proportion of opioid-naïve patients still consuming opioids 3 months after hospital discharge is 10.4%. At 6 months, the proportion is 4.4%. Unintentional chronic opioid use is associated with pre-operative opioid use, history of substance use, specific comorbidities, and invasive surgical procedures.
This systematic review suggests that the current discharge opioid prescribing practices can be improved. Lack of patient education regarding storage and disposal of opioids also contributes to the increasing rate of opioid misuse, diversion, and unintended long-term use. More high-quality research with comparable outcomes is needed. Evidence-based hospital guidelines and public health policies are needed to improve opioid stewardship.
越来越多的证据表明阿片类药物有不良影响。尽管如此，临床医生经常开出过多的出院阿片类药物。本系统评价的目的是分析住院患者出院后阿片类药物的潜在危害，包括过量开具出院阿片类药物、不当处理未使用的阿片类药物以及意外慢性阿片类药物使用。
截至 2018 年 12 月 1 日，系统检索 MEDLINE、EMBASE 和 Cochrane 数据库，以检索报告各种住院后出院阿片类药物潜在危害的研究。
28 项研究分析了各种住院手术或内科治疗后出院阿片类药物潜在危害。平均而言，患者仅使用了处方出院阿片类药物的 38%。72%的患者将剩余的阿片类药物存放在未上锁的地方，94.5%的患者未处理未使用的阿片类药物。这些因素可能导致社区中阿片类药物滥用和滥用的发生率增加。此外，出院阿片类药物导致阿片类药物使用时间延长；出院后 3 个月仍服用阿片类药物的阿片类药物初治患者比例为 10.4%；6 个月后，这一比例为 4.4%。意外慢性阿片类药物使用与术前阿片类药物使用、物质使用史、特定合并症和侵袭性手术有关。
本系统评价表明，目前的出院阿片类药物开具处方的做法可以改进。缺乏有关储存和处理阿片类药物的患者教育也导致阿片类药物滥用、滥用和意外长期使用的发生率增加。需要更多高质量的、具有可比性结果的研究。需要制定基于证据的医院指南和公共卫生政策，以改善阿片类药物管理。
