Predictors of Long‐Term Opioid Use After Opioid Initiation at Discharge From Medical and Surgical Hospitalizations

Abstract

Opioid analgesics may be initiated following surgical and medical hospitalization or in ambulatory settings; rates of subsequent long-term opioid (LTO) use have not been directly compared. This retrospective cohort study of the Veterans Health Administration (VHA) included all patients receiving a new outpatient opioid prescription from a VHA provider in fiscal year 2011. If a new outpatient prescription was filled within 2 days following hospital discharge, the initiation was considered a discharge prescription. LTO use was defined as an episode of continuous opioid supply lasting a minimum of 90 days and beginning within 30 days of the initial prescription. We performed bivariate and multivariate analyses to identify the factors associated with LTO use following surgical and medical discharges. Following incident prescription, 5.3% of discharged surgical patients, 15.2% of discharged medical patients, and 19.3% of outpatient opioid initiators received opioids long term. Medical and surgical patients differed; surgical patients were more likely to receive shorter prescription durations. Predictors of LTO use were similar in medical and surgical patients; the most robust predictor in both groups was the number of days' supply of the initial prescription (odds ratio [OR] = 1.24 and 95% confidence interval [CI], 1.12-1.37 for 8-14 days; OR = 1.56 and 95% CI, 1.39-1.76 for 15-29 days; and OR = 2.59 and 95% CI, 2.35-2.86 for >30 days) compared with the reference group receiving =7days. Rates of subsequent LTO use are higher among discharged medical patients than among surgical patients. Characteristics of opioid prescribing within the initial 30 days, including initial dose and days prescribed, were strongly associated with LTO use.

Long‐term opioid therapy definitions and predictors: A systematic review

“…Estimates of LTOT prevalence varied across studies by the population studied and LTOT definition used (Table ). For studies involving opioid‐naïve patients with surgery (n = 3), the prevalence of LTOT during study follow‐up ranged from 5.3% to 13% . The prevalence of LTOT among studies of opioid‐naïve patients (n = 4) with CNCP ranged from 1.3% to 25% .…”

“…Eleven definitions used days' supply, and only three definitions used daily use to identify LTOT, a stark contrast to traditional measures of adherence which often require days' supply in the definition . Only three definitions described methods used to account for gaps between prescriptions and overlapping prescriptions . Identifying consistent use is important because it more closely reflects actual opioid therapy characteristics, compared with fills at various time points during follow‐up.…”

“…For studies involving opioid-naïve patients with surgery (n = 3), the prevalence of LTOT during study follow-up ranged from 5.3% to 13%. 37,39 The prevalence of LTOT among studies of opioid-naïve patients (n = 4) with CNCP ranged from 1.3% to 25%. 40,41 Two studies did not provide enough information to calculate the LTOT prevalence.…”

“…23 Only three definitions described methods used to account for gaps between prescriptions and overlapping prescriptions. 39,41 Identifying consistent use is important because it more closely reflects actual opioid therapy characteristics, compared with fills at various time points during follow-up.…”

Improving the Safety of Opioid Use for Acute Noncancer Pain in Hospitalized Adults: A Consensus Statement From the Society of Hospital Medicine

“…3 Recent reports highlight that hospital use of opioids impacts downstream use. 4–6 Additionally, opioid prescribing practices vary between hospital-based providers and hospitals, 3,7 highlighting the need for prescribing standards and guidance. To our knowledge, there are no existing guidelines for improving the safety of opioid use in hospitalized patients outside of the intensive care or immediate peri-operative settings.…”