Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals

J Hosp Med. 2014 Feb;9(2):73-81. doi: 10.1002/jhm.2102. Epub 2013 Nov 13.


Background: Recent studies in the outpatient setting have demonstrated high rates of opioid prescribing and overdose-related deaths. Prescribing practices in hospitalized patients are unexamined.

Objective: To investigate patterns and predictors of opioid utilization in nonsurgical admissions to US hospitals, variation in use, and the association between hospital-level use and rates of severe opioid-related adverse events.

Design, setting, and patients: Adult nonsurgical admissions to 286 US hospitals.

Measurements: Opioid exposure and severe opioid-related adverse events during hospitalization, defined using hospital charges and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Results: Of 1.14 million admissions, opioids were used in 51%. The mean ± standard deviation daily dose received in oral morphine equivalents was 68 ± 185 mg; 23% of exposed received a total daily dose of ≥100 mg oral morphine equivalents. Opioid-prescribing rates ranged from 5% in the lowest-prescribing hospital to 72% in the highest-prescribing hospital (mean, 51% ± 10%). After adjusting for patient characteristics, the adjusted opioid-prescribing rates ranged from 33% to 64% (mean, 50% ± standard deviation 4%). Among exposed, 0.60% experienced severe opioid-related adverse events. Hospitals with higher opioid-prescribing rates had higher adjusted relative risk of a severe opioid-related adverse event per patient exposed (relative risk: 1.23 [1.14-1.33] for highest-prescribing compared with lowest-prescribing quartile).

Conclusions: The majority of hospitalized nonsurgical patients were exposed to opioids, often at high doses. Hospitals that used opioids most frequently had increased adjusted risk of a severe opioid-related adverse event per patient exposed. Interventions to standardize and enhance the safety of opioid prescribing in hospitalized patients should be investigated.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Cohort Studies
  • Drug Utilization / trends*
  • Female
  • Hospitalization / trends*
  • Hospitals / trends*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • United States / epidemiology
  • Young Adult


  • Analgesics, Opioid