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.
Researchers 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.