Opioid-Related Hospitalization and Its Association With Chronic Diseases: Findings From the National Inpatient Sample, 2011–2015

Rajbhandari‐Thapa, Janani; Zhang, Donglan; Padilla, Heather M.; Chung, Sae Rom

doi:10.5888/pcd16.190169

Cited by 17 publications

(18 citation statements)

References 15 publications

(13 reference statements)

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“…Further exacerbating the substance use epidemic is the prediction of the opioid epidemic’s “4th wave” or the rise in methamphetamine use among people with opioid use disorders [ 3 – 6 ]. People who use drugs (PWUD) such as opioids and methamphetamines face rising rates of HCV, HIV, and other chronic health conditions [ 7 – 9 ]. When rural PWUD attempt to access treatment for these health conditions, they face transportation barriers, stigma from healthcare providers, and a shortage of providers who offer care for substance use disorders (SUD) and their associated harms (e.g., HCV and HIV) [ 8 , 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional survey of potential factors, motivations, and barriers influencing research participation and retention among people who use drugs in the rural USA

Hetrick

Young

Elman

et al. 2021

Trials

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Background Despite high morbidity and mortality among people who use drugs (PWUD) in rural America, most research is conducted within urban areas. Our objective was to describe influencing factors, motivations, and barriers to research participation and retention among rural PWUD. Methods We recruited 255 eligible participants from community outreach and community-based, epidemiologic research cohorts from April to July 2019 to participate in a cross-sectional survey. Eligible participants reported opioid or injection drug use to get high within 30 days and resided in high-needs rural counties in Oregon, Kentucky, and Ohio. We aggregated response rankings to identify salient influences, motivations, and barriers. We estimated prevalence ratios to assess for gender, preferred drug use, and geographic differences using log-binomial models. Results Most participants were male (55%) and preferred methamphetamine (36%) over heroin (35%). Participants reported confidentiality, amount of financial compensation, and time required as primary influential factors for research participation. Primary motivations for participation include financial compensation, free HIV/HCV testing, and contribution to research. Changed or false participant contact information and transportation are principal barriers to retention. Respondents who prefer methamphetamines over heroin reported being influenced by the purpose and use of their information (PR = 1.12; 95% CI: 1.00, 1.26). Females and Oregonians (versus Appalachians) reported knowing and wanting to help the research team as participation motivation (PR = 1.57; 95% CI: 1.09, 2.26 and PR = 2.12; 95% CI: 1.51, 2.99). Conclusions Beyond financial compensation, researchers should emphasize confidentiality, offer testing and linkage with care, use several contact methods, aid transportation, and accommodate demographic differences to improve research participation and retention among rural PWUD.

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Section: Introductionmentioning

confidence: 99%

A cross-sectional survey of potential factors, motivations, and barriers influencing research participation and retention among people who use drugs in the rural USA

Hetrick

Young

Elman

et al. 2021

Trials

View full text Add to dashboard Cite

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“…In the cohort of opioid initiators, we identified cases of ORAE using the International Classification of Diseases , Ninth or Tenth Revision , Clinical Modification (ICD-9 or ICD-10 CM) Codes recorded in inpatient or outpatient encounter claims during follow-up. These codes have been used by the CDC and Agency for Healthcare Research and Quality (AHRQ) to define ORAEs, including opioid misuse (ICD-9 codes: 305.50–305.52), opioid dependence and unspecified use (304.00–304.02, 304.70–304.72), opioid poisoning (965.00–965.02, 965.09, 970.1, E850.0-E850.2), and adverse effects of opioids (E-codes: E935.0-E935.2, E940.1) [ 1 , 3 ]. We also used the ICD-9-CM to ICD-10-CM code conversion of ORAEs provided by AHRQ ( S1 Table ) [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…The number of older adults who had medical encounters for treatment of opioid misuse, dependence, and poisoning has increased disproportionately over the past decade [ 1 ]. The opioid-related adverse events (ORAEs) defined by the United States (US) government agencies [ 1 – 3 ] contain diagnostic codes commonly used for opioid use disorder (OUD) and overdose from use of illicit opioids (i.e., heroin) or incorrect use of prescribed opioids, as well as E codes for severe adverse effects from use of heroin or correct use of prescribed opioids that lead to hospital or emergency department visits. The rate of hospital stays and emergency department visits due to ORAEs rose by 34% (from 199.3 stays to 267.6 stays per 100,000 persons) and 74% (from 44.7 visits to 77.9 visits per 100,000 persons), respectively, among older patients between 2010 and 2015 [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: A nested case–control study

et al. 2022

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Background Despite the rising number of older adults with medical encounters for opioid misuse, dependence, and poisoning, little is known about patterns of prescription opioid dose and their association with risk for opioid-related adverse events (ORAEs) in older patients. The study aims to compare trajectories of prescribed opioid doses in 6 months preceding an incident ORAE for cases and a matched control group of older patients with chronic noncancer pain (CNCP). Methods and findings We conducted a nested case–control study within a cohort of older (≥65 years) patients diagnosed with CNCP who were new users of prescription opioids, assembled using a 5% national random sample of Medicare beneficiaries from 2011 to 2018. From the cohort with a mean follow-up of 2.3 years, we identified 3,103 incident ORAE cases with ≥1 opioid prescription in 6 months preceding the event, and 3,103 controls matched on sex, age, and time since opioid initiation. Key exposure was trajectories of prescribed opioid morphine milligram equivalent (MME) daily dosage over 6 months before the incident ORAE or matched controls. Among the cases and controls, 2,192 (70.6%) were women, and the mean (SD) age was 77.1 (7.1) years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily MME, 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Few older patients (<5%) were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low dose, moderate dose, and increase dose were more likely to be younger (65 to 74 years), Midwest US residents, and receiving no low-income subsidy. Compared to patients with gradual dose discontinuation, those with gradual dose increase (adjusted odds ratio [aOR] = 3.4; 95% confidence interval (CI) 2.8 to 4.0; P < 0.001), consistent low dose (aOR = 3.8; 95% CI 3.2 to 4.6; P < 0.001), and consistent moderate dose (aOR = 8.5; 95% CI 6.8 to 10.7; P < 0.001) had a higher risk of ORAE, after adjustment for covariates. Our main findings remained robust in the sensitivity analysis using a cohort study with inverse probability of treatment weighting analyses. Major limitations include the limited generalizability of the study findings and lack of information on illicit opioid use, which prevents understanding the clinical dose threshold level that increases the risk of ORAE in older adults. Conclusions In this sample of older patients who are Medicare beneficiaries, 4 prescription opioid dose trajectories were identified, with most prescribed doses below 90 daily MME within 6 months before ORAE or matched date. An increased risk for ORAE was observed among older patients with a gradual increase in dose or among those with a consistent low-to-moderate dose of prescribed opioids when compared to patients with opioid dose discontinuation. Whether older patients are susceptible to low opioid doses warrants further investigations.

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“…Patients with opioid-related conditions, including opioid dependence and opioid use disorder (OUD), are commonly hospitalized for the treatment of infections, trauma or other emergent conditions, with admission rates increasing as the opioid overdose crisis continues [ 1 – 3 ]. Unfortunately, patients with substance use disorders (SUD) are much more likely to self-discharge against medical advice (referred to in this paper as self-directed discharge [ 4 ]) than patients admitted for similar conditions without SUDs [ 5 , 6 ], which can lead to poorer health outcomes including worsening of illness, readmissions and death [ 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study

et al. 2021

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Background Patients with substance use disorders are more likely than those without to have a self-directed hospital discharge, putting them at risk for poor health outcomes including progressing illness, readmissions, and death. Inadequate pain management has been identified as a potential motivator of self-directed discharge in this patient population. The objective of this study was to describe the association between acute pain and self-directed discharges among persons with opioid-related conditions; the presence of chronic pain in self-directed discharges was likewise considered. Methods We employed a large database of all hospitalizations at acute care hospitals during 2017 in the city of Philadelphia to identify adults with opioid-related conditions and compare the characteristics of admissions ending with routine discharge versus those ending in self-directed discharge. We examined all adult discharges with an ICD-10 diagnoses related to opioid use or poisoning and inspected the diagnostic data to systematically identify acute pain for the listed primary diagnosis and explore patterning in chronic pain diagnoses with respect to discharge outcomes. Results Sixteen percent of the 7972 admissions involving opioid-related conditions culminated in self-directed discharge, which was more than five times higher than in the general population. Self-directed discharge rates were positively associated with polysubstance use, nicotine dependence, depression, and homelessness. Among the 955 patients with at least one self-directed discharge, 15.4% had up to 16 additional self-directed discharges during the 12-month observation period. Those admitted with an acutely painful diagnosis were almost twice as likely to complete a self-directed discharge, and for patients with multiple admissions, rates of acutely painful diagnoses increased with each admission coinciding with a cascading pattern of worsening infectious morbidity over time. Chronic pain diagnoses were inconsistent for those patients with multiple admissions, appearing, for the same patient, in one admission but not others; those with inconsistent documentation of chronic pain were substantially more likely to self-discharge. Conclusions These findings underscore the importance of pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial cost and suffering. Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain.

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Opioid-Related Hospitalization and Its Association With Chronic Diseases: Findings From the National Inpatient Sample, 2011–2015

Cited by 17 publications

References 15 publications

A cross-sectional survey of potential factors, motivations, and barriers influencing research participation and retention among people who use drugs in the rural USA

A cross-sectional survey of potential factors, motivations, and barriers influencing research participation and retention among people who use drugs in the rural USA

Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: A nested case–control study

Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study

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