Patterns of Opioid Administration Among Opioid-Naive Inpatients and Associations With Postdischarge Opioid Use: A Cohort Study

Abstract

Background: Patterns of inpatient opioid use and their associations with postdischarge opioid use are poorly understood.

Objective: To measure patterns in timing, duration, and setting of opioid administration in opioid-naive hospitalized patients and to examine associations with postdischarge use.

Design: Retrospective cohort study using electronic health record data from 2010 to 2014.

Setting: 12 community and academic hospitals in Pennsylvania.

Patients: 148 068 opioid-naive patients (191 249 admissions) with at least 1 outpatient encounter within 12 months before and after admission.

Measurements: Number of days and patterns of inpatient opioid use; any outpatient use (self-report and/or prescription orders) 90 and 365 days after discharge.

Results: Opioids were administered in 48% of admissions. Patients were given opioids for a mean of 67.9% (SD, 25.0%) of their stay. Location of administration of first opioid on admission, timing of last opioid before discharge, and receipt of nonopioid analgesics varied substantially. After adjustment for potential confounders, 5.9% of inpatients receiving opioids had outpatient use at 90 days compared with 3.0% of those without inpatient use (difference, 3.0 percentage points [95% CI, 2.8 to 3.2 percentage points]). Opioid use at 90 days was higher in inpatients receiving opioids less than 12 hours before discharge than in those with at least 24 opioid-free hours before discharge (7.5% vs. 3.9%; difference, 3.6 percentage points [CI, 3.3 to 3.9 percentage points]). Differences based on proportion of the stay with opioid use were modest (opioid use at 90 days was 6.4% and 5.4%, respectively, for patients with opioid use for ≥75% vs. ≤25% of their stay; difference, 1.0 percentage point [CI, 0.4 to 1.5 percentage points]). Associations were similar for opioid use 365 days after discharge.

Limitation: Potential unmeasured confounders related to opioid use.

Conclusion: This study found high rates of opioid administration to opioid-naive inpatients and associations between specific patterns of inpatient use and risk for long-term use after discharge.

Primary funding source: UPMC Health System and University of Pittsburgh.

Appendix Figure.

Study flow diagram.

Figure 1.

Inpatient opioid use among opioid-naive patients, with adjustment for patient- and stay-level characteristics. IRRs were estimated using a multivariable Poisson model that included 191 249 hospital stays. The dependent variable was the number of days with opioid administration. Length of hospital stay (log-transformed) was treated as an offset term. Error bars indicate 95% CIs. HCUP CCS = Healthcare Cost and Utilization Project Clinical Classifications Software; ICU = intensive care unit; IRR = incidence rate ratio.

Figure 2.

Duration (A), timing (B), setting of administration of first opioid (C), and nonopioid administration (D) among opioid-naive patients who received opioids in the hospital, by admission type. Patterns of opioid administration reported for 92 433 stays during which ≥1 opioid was administered and that met all other study inclusion criteria. ED = emergency department; ICU = intensive care unit; PACU = postanesthesia care unit.