Original Article

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

Authors: Kaitlin E. Keenan, MD, Michael B. Rothberg, MD, MPH, Shoshana J. Herzig, MD, MPH, Simon Lam, PharmD, BCPS, Vicente Velez, MD, Kathryn A. Martinez, PhD, MPH


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.

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