Keenan Kaitlin E, Rothberg Michael B, Herzig Shoshana J, Lam Simon, Velez Vicente, Martinez Kathryn A
From Rush University Medical Center, Chicago, Illinois, the Departments of Internal Medicine, Hospital Medicine and Pharmacy, Cleveland Clinic, Cleveland, Ohio, and the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
South Med J. 2021 Oct;114(10):623-629. doi: 10.14423/SMJ.0000000000001307.
Opioid receipt during medical hospitalizations may be associated with subsequent long-term use. Studies, however, have not accounted for pain, which may explain chronic use. The objective of this study was to identify the association between opioid exposure during a medical hospitalization and use 6 to 12 months later.
This was an observational cohort study using electronic health record data from 10 hospitals in the Cleveland Clinic Health System in 2016. Eligible patients were opioid-naïve adults with pain age 18 years and older, admitted to a medical service. Outcomes were opioid receipt during hospitalization and on discharge, and long-term opioid use, defined as ≥2 prescriptions for at least 30 pills 6 to 12 months posthospitalization. We estimated the odds of long-term opioid use by opioid exposure during the hospitalization. Models controlled for patient demographic and clinical characteristics, including patient-reported pain.
Among the 2971 patients in the sample, 64% received opioids during their hospitalization and 28% were discharged with opioids. Overall, 3% of patients had long-term use. Higher pain score was associated with greater odds of long-term use (adjusted odds ratio [aOR] per point increase 1.11; 95% confidence interval [CI] 1.03-1.19). No patient factors were associated with long-term use. Receipt of an opioid during a hospitalization only was not associated with long-term use (aOR 1.44, 95% CI 0.81-2.57), but receipt at discharge was (aOR 1.96, 95% CI 1.08-3.56).
Although opioid receipt at discharge was associated with long-term use, the number of patients this applied to was small. Pain severity was an important predictor of long-term use and should be accounted for in future studies.
