Clinical

Discharge opioid prescriptions for many surgical hospitalizations may be unnecessary


 


Background: Prescription opioids play a significant role in the current opioid epidemic. Opioids used for nonmedical purposes often are obtained from the prescription of friends and family members, and a majority of heroin users report that their first opioid exposure was via a prescription opioid. Prescription of opioids following low-risk surgical procedures has increased over the past decade.


Study design: Cross-sectional study.

Setting: Two Boston-area acute care hospitals from May 2014 to September 2016.

Synopsis: The authors identified 6,548 inpatient surgical hospitalizations lasting longer than 1 day with a discharge to home in which the patient used no opioid medications in the final 24 hours prior to discharge. Of these, 43.7% received an opioid prescription at discharge. The mean prescription morphine milligram equivalents (MME) provided to this group was 343. The authors identified these cases as instances in which overprescription of opiates may have occurred. Surgical services that tended to have more patients still using opioids at the time of discharge had a higher likelihood of potential overprescription. For patients who used opioids during the final 24 hours of their hospitalization and received an opioid prescription at discharge, inpatient MME use and prescription MME were only weakly correlated (R2 = 0.112). The retrospective two-site design of this study may limit its generalizability.

Bottom line: In postoperative surgical patients, overprescription of opioid medications may occur frequently.

Citation: Chen EY et al. Correlation between 24-hour predischarge opioid use and amount of opioids prescribed at hospital discharge. JAMA Surg. 2018;153(2):e174859.

Dr. Salber is a hospitalist at Beth Israel Deaconess Medical Center, and instructor in medicine, Harvard Medical School, Boston.

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