Study: Hospitals Often Prescribe Pain Meds in High Doses

Study: Hospitals Often Prescribe Pain Meds in High Doses

A large study of opioid prescribing practices in hospitals has found that over half of all nonsurgical patients were given painkillers — often at very high doses — and many were still receiving the medications on the day they were discharged from the hospital.

bigstock-Prescription-Medication-1608757-195x300Researchers at Beth Israel Deaconess Medical Center (BIDMC) analyzed data from 1.14 million adult patients who were treated at 286 hospitals in 2009 and 2010. The patients were admitted for nonsurgical reasons, including acute infections, heart problems, cancer, musculoskeletal injuries, and other diagnoses.

“Realizing that inpatient use might provide a portal to outpatient use, we were interested in looking at how opioids were being used in the hospital setting,” said lead author Shoshana Herzig, MD, of BIDMC’s Division of General Medicine and Primary Care and an instructor in Medicine at Harvard Medical School.

“Because patients who are undergoing surgery have a clear indication for and virtually always receive these pain medications, we did not include surgical patients in our study. Instead, we chose to examine only individuals who were admitted to the hospital for nonsurgical reasons.”

The researchers found that 43% of the nonsurgical patients were exposed to multiple opioids during their hospitalization, with the average dose being about 68 milligrams of oral morphine equivalents per day.

Nearly one in four (23%) received a dose equal to or greater than 100 milligrams on at least one day during their hospitalization.

“That’s a very high dose,” said Herzig. “Patients receiving doses of 100 mg per day or more are at substantially greater risk for serious problems, including severe breathing problems.”

Also of concern, according to Herzig, is that 26% of the patients received opioids on the day they were discharged from the hospital.

“This finding suggests that up to half of these patients were sent home with a prescription for opioid medication,” adds Herzig, “Unless physicians are diligent about checking on other opioid prescriptions that a patient may have received in another setting, this means that patients could wind up with multiple opioid prescriptions, thus increasing the likelihood of an inadvertent overdose or other adverse event.”

The researchers also found distinct regional differences in the prescribing of opioids to nonsurgical patients. Hospitals in western states were 37% more likely to prescribe opioids than those in the northeast.

“In other words, hospitals that used these drugs more frequently did so less safely,” Herzig said..

“Taken together, our findings really emphasize the importance of good communication between inpatient and outpatient providers. It’s important that primary care physicians know what medications their patients have been exposed to during hospitalizations. We hope this information will prompt hospitals to take a closer look at their own opioid-prescribing practices.”

The study is published online in The Journal of Hospital Medicine.

Authored by: Pat Anson, Editor

There are 4 comments for this article
  1. Ryan Lankford at 3:19 pm

    If you think that “addiction” and “dependency” are interchangeable terms, you probably shouldn’t be commenting on issues like this.

  2. StoppNow at 8:37 am

    All physicians should be prescribing Narcan when they prescribe opioids. The warning label on Purdue Pharma’s oxycontin in fact indicates overdose as an adverse effect. Every post op patient sent home with a prescription for oxy needs to have Narcan. The warning label also indicates “dependency” as an adverse effect. Unfortunately, our society prefers its own label of “addiction”. Perhaps if Purdue Pharma used the word “addiction” rather than “dependency”, people would be then be “informed” appropriately. And, if a prescription for Narcan, in the event of the adverse effect of overdosing as labeled, was also written, people would then be “informed” appropriately. Is that every patient’s right? After reading “Patient’s Bill of Rights”, you will agree. As a patient, you do have rights to be fully informed. Physicians have failed to do this, and our country is now in an “physician prescribed drug epidemic”.

    Doctor’s need to clearly tell patients that they have a risk of addiction and overdosing.

    Now lets look at the whole picture, if Purdue Pharma changed the labeling words “dependency” to addiction”, and required a dual prescription for Narcan to address the proven overdose risk that is on the drug label……oh, sorry, they would no longer be in business, as the patient would be CLEARLY INFORMED.

    The medical community has failed in one of the basic rights a patient has; information. Grossly negligent and in violation of every patient’s right.

  3. Shirley at 6:11 pm

    I didn’t get anything for pain and we in pain te we ime they sy I’m an addicted but I wear to all I’m not I like to have a clear head without pain i take just enough to make me comfortable to do my normal everyday living things and I haven’t been able to do any of these things for more than 8 or 9 years I was in pain for years before this but kept on keepin’ on but now it’s just to HARD…Moon

  4. Steve at 5:01 am

    100mg MED (morphine equivalent dosage) is NOT extremely high, it’s not even a high dose, especially for patients in chronic pain.

    Opioids are some of the safest medications on the planet. NSAIDs kill more people than all prescription opioids COMBINED. Acetaminophen/paracetamol/Tylenol kills more people than all opioids, INCLUDING diacetylmorphine/diamorphine/Heroin, combined. They should gave also excluded any patients already receiving opioids for chronic pain. I’m sure almost every cancer patient received opioids before they were admitted and were continued on them. The patients on opioids when admitted would obviously be continued on opioids.

    Even new opioid prescriptions aren’t surprising given the epidemic of opioid underprescribing.

    Statistics can be used to vilify any drug or behavior, usually without much truth.