By Susan E. Matthews
More than half of all nonsurgical hospital patients are prescribed opioid painkillers during their stay, a new analysis of 286 hospitals found. The research, published in the Journal of Hospital Medicine, also found that prescribing rates differed between hospitals and regions, and may be contributing to opioid addiction and overdoses.
Researchers from Beth Israel Deaconess Medical Center in Boston, Harvard Medical School, and the Cleveland Clinic, studied all adult nonsurgical records collected from 286 hospitals, for one year, from July 2009 to June 2010. They analyzed a total of 1.14 million admissions to analyze and found that of these nonsurgical admissions, 51 percent were prescribed opioids at some point during their hospital stay.
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The study is one of the first to look at prescription levels for nonsurgical patients in hospitals, said study author Shani Herzig, MD, hospitalist at Beth Israel Deaconess. Due to increased reports of opioid abuse and overdose, the researchers decided to look at the issue. "Inpatient use could be one portal for outpatient use," Dr. Herzig said.
Keith Berge, MD, an anesthesiologist at the Mayo Clinic, said he found the high prescription rates surprising, and that they point to the problem of increasing use of opioid medications. "There's increased use and there follows inevitably increased diversion of these drugs to misuse," he said, which causes more addiction and death.
The results were surprisingly high, she said, noting that they only considered nonsurgical patients because almost all surgical patients are prescribed opioids. Perhaps the cause of the high rate is that about a decade ago, a new campaign to interpret pain as a vital sign encouraged healthcare professionals to ask patients about their pain levels more frequently.
"It heightened emphasis on controlling pain, and was more of a move toward making sure patients don't experience any pain ever," Herzig said.
A patient who came in with a sprained ankle used to simply be taped up, but today, that same patient would get oral opioids, Dr. Berge said. This is a problem given the increasing rates of opioid abuse, he said. Fatal overdoses of opioids have quadrupled over the last decade, according to the CDC.
Additionally, half of the patients prescribed opioids during their hospital stay were still on the drugs the day they left. Because it's necessary to taper off opioids, it's likely that they continued to take them at home, said Herzig, though the study didn't include whether patients had an opioid prescription when leaving the hospital. This increases the risk that patients have multiple prescriptions -- one from the hospital and one from a normal doctor -- which increases the risk of addiction or overdose.
Opioids are particularly dangerous because one of the side effects is respiratory depression, which means that the patient could stop breathing. This can result in death, and is part of what makes opioids so dangerous. The side effect is much more likely once patients receive a dose of more than 100 milligrams a day, and the researchers found that 23 percent of those receiving opioids did receive 100 mg or more, Herzig said.
The researchers also noted that there was wide variation in how many patients were prescribed opioids during their stay. For example, at the hospital with the lowest levels, only 5 percent of patients got the prescription, while at the highest prescribing hospital, 72 percent did.
This could mean that some hospitals are overusing while others are underutilizing opioids, said Berge. "It's hard to say who is doing it right -- there's room for improvement," he said.
This also was observed regionally -- a patient at a hospital in the west was 37 percent more likely to get an opioid prescription as a similar patient in the Northeast, the study found.
"The results could suggest some use is potentially unnecessary and driven by the preferences of the provider," Herzig said. Herzig suggested that patients talk to their doctors about their medication preferences, as there are powerful painkillers that are not opioids that may be just as effective.
"More Than Half of Nonsurgical Hospital Patients Get Opioids" originally appeared in Everyday Health.