Association between Opioids Prescribed to Medical Inpatients with Pain and Long-Term Opioid Use

South Med J. 2021 Oct;114(10):623-629. doi: 10.14423/SMJ.0000000000001307.


Objectives: Opioid receipt during medical hospitalizations may be associated with subsequent long-term use. Studies, however, have not accounted for pain, which may explain chronic use. The objective of this study was to identify the association between opioid exposure during a medical hospitalization and use 6 to 12 months later.

Methods: This was an observational cohort study using electronic health record data from 10 hospitals in the Cleveland Clinic Health System in 2016. Eligible patients were opioid-naïve adults with pain age 18 years and older, admitted to a medical service. Outcomes were opioid receipt during hospitalization and on discharge, and long-term opioid use, defined as ≥2 prescriptions for at least 30 pills 6 to 12 months posthospitalization. We estimated the odds of long-term opioid use by opioid exposure during the hospitalization. Models controlled for patient demographic and clinical characteristics, including patient-reported pain.

Results: Among the 2971 patients in the sample, 64% received opioids during their hospitalization and 28% were discharged with opioids. Overall, 3% of patients had long-term use. Higher pain score was associated with greater odds of long-term use (adjusted odds ratio [aOR] per point increase 1.11; 95% confidence interval [CI] 1.03-1.19). No patient factors were associated with long-term use. Receipt of an opioid during a hospitalization only was not associated with long-term use (aOR 1.44, 95% CI 0.81-2.57), but receipt at discharge was (aOR 1.96, 95% CI 1.08-3.56).

Conclusions: Although opioid receipt at discharge was associated with long-term use, the number of patients this applied to was small. Pain severity was an important predictor of long-term use and should be accounted for in future studies.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage*
  • Cohort Studies
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitalization / trends
  • Humans
  • Inpatients / statistics & numerical data*
  • Male
  • Middle Aged
  • Ohio
  • Pain Management / methods*
  • Pain Management / standards
  • Pain Management / statistics & numerical data
  • Retrospective Studies
  • Time


  • Analgesics, Opioid