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Half of patients admitted to U.S. hospitals for nonsurgical reasons were given opioids during their stay, according to a large national database review.
The medications were also given in relatively high doses – a mean of 70 mg oral morphine equivalents daily overall, but 100 mg or higher in about a quarter of patients, Dr. Shoshana Herzig said at the annual meeting of the Society of Hospital Medicine.
"Given the prevalence of high-dose exposure, the known risks of these drugs, and the older age of many recipients, opportunities exist to make opioid use safer in patients," said Dr. Herzig of Beth Israel Deaconess Medical Center, Boston.
Dr. Herzig used data extracted from a large, national hospital database. The database contains administrative information from 600 U.S. hospitals, and reflects about 25% of the nation’s annual hospital discharges.
For this analysis, she selected 1.14 million nonsurgical admissions that occurred among 286 hospitals from July 2009 to June 2010. Opioid exposure was defined as at least one charge for an opioid medication during the admission or on the day of discharge. The database does not provide information about discharge prescriptions, nor does it describe in detail the pain complaint associated with the charge.
The patients’ median age was 64 years; 46% were male. Morphine was the most commonly prescribed (20%), followed by hydrocodone (14%), and hydromorphone (13%). Patients received the drugs parenterally (66%), orally (65%), or both.
Overall, opioids were used in 51% of admissions, including 45% of patients aged 65 years and older. Many patients (43%) received two or more different opioids. More than half of those who took the drugs during their stay (52%) also had them on the day of discharge.
The observed rate of opioid use varied considerably among the hospitals, ranging from 5% in the lowest-prescribing hospital to 72% in the highest-prescribing hospital, with a mean of 51%.
Dr. Herzig found regional differences as well, with the highest use in Western states (55% of all admissions), followed by Southern states (53% of admissions), the Midwest (50%), and the Northeast (39%).
A multivariate analysis that controlled for patient demographics, comorbidities, and hospital characteristics found a number of significant associations with opioid use.
Compared with whites and Hispanics, black patients were less likely to receive the drugs (odds ratio, 0.93). Patients with musculoskeletal injuries were most likely to receive opioids (OR, 2.0), as were patients with cancer (OR, 1.2). Psychiatric and alcohol admissions were significantly less likely to get opioids (OR, 0.37 and 0.46, respectively), but there was no significant relationship with an admission for substance abuse.
Some typically painful procedures significantly predicted opioid use, including cardiovascular procedures (OR, 1.8), gastrointestinal procedures (OR, 1.7), and mechanical ventilation (OR, 1.4).
The analysis didn’t allow any conclusions to be drawn about causality, Dr. Herzig said, but the findings call for more research. "Increased attention should be paid to the role that inpatient opioid prescribing plays in the increased rates of chronic opioid use and overdose-related deaths in the United States."
Dr. Herzig had no financial declarations.
Half of patients admitted to U.S. hospitals for nonsurgical reasons were given opioids during their stay, according to a large national database review.
The medications were also given in relatively high doses – a mean of 70 mg oral morphine equivalents daily overall, but 100 mg or higher in about a quarter of patients, Dr. Shoshana Herzig said at the annual meeting of the Society of Hospital Medicine.
"Given the prevalence of high-dose exposure, the known risks of these drugs, and the older age of many recipients, opportunities exist to make opioid use safer in patients," said Dr. Herzig of Beth Israel Deaconess Medical Center, Boston.
Dr. Herzig used data extracted from a large, national hospital database. The database contains administrative information from 600 U.S. hospitals, and reflects about 25% of the nation’s annual hospital discharges.
For this analysis, she selected 1.14 million nonsurgical admissions that occurred among 286 hospitals from July 2009 to June 2010. Opioid exposure was defined as at least one charge for an opioid medication during the admission or on the day of discharge. The database does not provide information about discharge prescriptions, nor does it describe in detail the pain complaint associated with the charge.
The patients’ median age was 64 years; 46% were male. Morphine was the most commonly prescribed (20%), followed by hydrocodone (14%), and hydromorphone (13%). Patients received the drugs parenterally (66%), orally (65%), or both.
Overall, opioids were used in 51% of admissions, including 45% of patients aged 65 years and older. Many patients (43%) received two or more different opioids. More than half of those who took the drugs during their stay (52%) also had them on the day of discharge.
The observed rate of opioid use varied considerably among the hospitals, ranging from 5% in the lowest-prescribing hospital to 72% in the highest-prescribing hospital, with a mean of 51%.
Dr. Herzig found regional differences as well, with the highest use in Western states (55% of all admissions), followed by Southern states (53% of admissions), the Midwest (50%), and the Northeast (39%).
A multivariate analysis that controlled for patient demographics, comorbidities, and hospital characteristics found a number of significant associations with opioid use.
Compared with whites and Hispanics, black patients were less likely to receive the drugs (odds ratio, 0.93). Patients with musculoskeletal injuries were most likely to receive opioids (OR, 2.0), as were patients with cancer (OR, 1.2). Psychiatric and alcohol admissions were significantly less likely to get opioids (OR, 0.37 and 0.46, respectively), but there was no significant relationship with an admission for substance abuse.
Some typically painful procedures significantly predicted opioid use, including cardiovascular procedures (OR, 1.8), gastrointestinal procedures (OR, 1.7), and mechanical ventilation (OR, 1.4).
The analysis didn’t allow any conclusions to be drawn about causality, Dr. Herzig said, but the findings call for more research. "Increased attention should be paid to the role that inpatient opioid prescribing plays in the increased rates of chronic opioid use and overdose-related deaths in the United States."
Dr. Herzig had no financial declarations.
Half of patients admitted to U.S. hospitals for nonsurgical reasons were given opioids during their stay, according to a large national database review.
The medications were also given in relatively high doses – a mean of 70 mg oral morphine equivalents daily overall, but 100 mg or higher in about a quarter of patients, Dr. Shoshana Herzig said at the annual meeting of the Society of Hospital Medicine.
"Given the prevalence of high-dose exposure, the known risks of these drugs, and the older age of many recipients, opportunities exist to make opioid use safer in patients," said Dr. Herzig of Beth Israel Deaconess Medical Center, Boston.
Dr. Herzig used data extracted from a large, national hospital database. The database contains administrative information from 600 U.S. hospitals, and reflects about 25% of the nation’s annual hospital discharges.
For this analysis, she selected 1.14 million nonsurgical admissions that occurred among 286 hospitals from July 2009 to June 2010. Opioid exposure was defined as at least one charge for an opioid medication during the admission or on the day of discharge. The database does not provide information about discharge prescriptions, nor does it describe in detail the pain complaint associated with the charge.
The patients’ median age was 64 years; 46% were male. Morphine was the most commonly prescribed (20%), followed by hydrocodone (14%), and hydromorphone (13%). Patients received the drugs parenterally (66%), orally (65%), or both.
Overall, opioids were used in 51% of admissions, including 45% of patients aged 65 years and older. Many patients (43%) received two or more different opioids. More than half of those who took the drugs during their stay (52%) also had them on the day of discharge.
The observed rate of opioid use varied considerably among the hospitals, ranging from 5% in the lowest-prescribing hospital to 72% in the highest-prescribing hospital, with a mean of 51%.
Dr. Herzig found regional differences as well, with the highest use in Western states (55% of all admissions), followed by Southern states (53% of admissions), the Midwest (50%), and the Northeast (39%).
A multivariate analysis that controlled for patient demographics, comorbidities, and hospital characteristics found a number of significant associations with opioid use.
Compared with whites and Hispanics, black patients were less likely to receive the drugs (odds ratio, 0.93). Patients with musculoskeletal injuries were most likely to receive opioids (OR, 2.0), as were patients with cancer (OR, 1.2). Psychiatric and alcohol admissions were significantly less likely to get opioids (OR, 0.37 and 0.46, respectively), but there was no significant relationship with an admission for substance abuse.
Some typically painful procedures significantly predicted opioid use, including cardiovascular procedures (OR, 1.8), gastrointestinal procedures (OR, 1.7), and mechanical ventilation (OR, 1.4).
The analysis didn’t allow any conclusions to be drawn about causality, Dr. Herzig said, but the findings call for more research. "Increased attention should be paid to the role that inpatient opioid prescribing plays in the increased rates of chronic opioid use and overdose-related deaths in the United States."
Dr. Herzig had no financial declarations.
AT HOSPITAL MEDICINE 2013
