Background: Efforts to reduce and monitor high-risk opioid prescribing have largely focused on outpatient prescribing with less empiric evaluation of inpatient administration. Little is known about the association of inpatient opioid administration and postdischarge opioid use.
Dr. Russell Ledford
Study design: Retrospective cohort.
Setting: 12 community and academic hospitals in Pennsylvania.
Synopsis: With electronic health record data from 2010-2014 to evaluate 148,068 opioid-naive patients aged 18 years and older, this study showed a relationship between inpatient opioid administration, specific patterns of inpatient opioid administration, and postdischarge opioid use. Specifically, inpatient opioid administration was associated with a 3.0% increase (95% CI, 2.8%-3.2%) in opioid use at 90 days post discharge. Additionally, inpatient opioid administration within 12 hours of hospital discharge was associated with a 3.6% increase (95% CI, 3.3%-3.9%) in opioid use at 90 days post discharge.
This observational study is prone to potential unmeasured confounders negating any clear causation. Rather, hospitalists should be aware of the increasing focus on inpatient opioid administration as it relates to outpatient opioid use, especially in the setting of the current opioid crisis.
Bottom line: Inpatient opioid administration and administration patterns are associated with 90-day postdischarge opioid use in opioid-naive patients.
Citation: Donohue JM et al. Patterns of opioid administration among opioid-naive inpatients and associations with postdischarge opioid use. Ann Intern Med. 2019 Jun 18:171(2):81-90.
Dr. Ledford is a hospitalist at Vanderbilt University Medical Center, Nashville, Tenn.