Authors: Ricki Lewis, PhD
About 15% of a group of Medicare patients who had not used opioid medications in the previous 2 months filled opioid prescriptions within a week of hospital discharge, according to a research report published online June 13 in JAMA Internal Medicine. A second report finds “suboptimal” practices related to sharing, storing, and disposing of opioids, as well as poor communication of information on these topics to patients.
Prescription of opioid drugs with discharge from the hospital is often necessary to manage pain, but introduces risk for dependency. Deaths attributed to prescription opioids more than tripled from 1999 to 2014 in the United States.
Hospitals may be encouraged to prescribe opioids upon discharge in response to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative, which asks patients about satisfaction with pain control in the hospital. The Promoting Responsible Opioid Prescribing Act of 2016 will investigate whether HCAHPS is incentivizing hospital-associated opioid use.
Anupam B. Jena, MD, PhD, from the Department of Health Care Policy, Harvard Medical School, and the Department of Medicine, Massachusetts General Hospital, Boston, and colleagues conducted an observational study using prescription drug claims data from a random sample of Medicare beneficiaries who were hospitalized in 2011 and without an opioid prescription claim within the last 60 days. They considered the frequency of prescription filling within a week of discharge, assessed variation in prescribing rates among hospitals, and investigated characteristics of patients and hospitals.
New opioid prescriptions were filled within a week of discharge for 92,882 (14.9%) of 623,957 individuals hospitalized. Postdischarge opioid use ranged from 10.5% in the bottom decile of hospitals to 20.0% in the top decile. Among the 77,092 patients with 90-day follow-up, 32,731 (42.5%) had submitted an opioid claim after 90 days postdischarge.
Patient factors associated with new opioid use included younger age, living in rural areas, receiving low-income subsidies, and eligibility for Medicare and Medicaid. Surgical hospitalization was most likely for burns, female reproductive indications, and diseases of the liver and gallbladder. Medical hospitalizations were most likely for connective tissue or musculoskeletal disorders. Opioid use past the 90-day mark was also associated with these indications.
The investigators found a positive association between postdischarge opioid use and a hospital’s HCAHPS measure of percentage of inpatients reporting well-managed pain. They also discovered a positive association between number of full-time registered nurses per bed and postdischarge opioid use and a negative association with the number of full-time resident physicians per bed. Higher rates were found for rural, government, and system-affiliated facilities.
The researchers conclude that “among Medicare patients without opioid use in the 60 days prior to hospitalization, prescribing of opioids at the time of hospital discharge is common, with substantial variation across hospitals and a large proportion of patients using a prescription opioid 90 days after hospitalization.”
The study did not indicate whether variation in postdischarge opioid use was related to variation in appropriate vs inappropriate prescribing, and did not distinguish opioids prescribed in an outpatient setting within the 7-day timeframe.
“Every day, 44 people in the United States die from prescription drug overdoses, especially opioid overdose. It’s critical that we understand hospital prescribing patterns so that we can make sure we are prescribing these medications safely and effectively without fueling this deadly crisis,” said Dr Jena in a Harvard news release.
In a research letter also published online June 13 in JAMA Internal Medicine, Alene Kennedy-Hendricks, PhD, from Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and colleagues claim that current practices related to sharing, storing, and disposing of opioid medications and communication to patients on these topics are “suboptimal.”
The researchers used national survey results obtained over the course of a month in 2015 by GfK Knowledge Panel, a market research company that surveys consumers. Questions probed beliefs and practices about sharing, storing, and disposing of opioids and asked where respondents learned about these topics.
Among 1055 respondents who had used opioids within the last year, 1032 (97.8%) completed the survey, and 20.7% of them reported sharing the drugs, primarily for pain management (73.0%). However, only 13.7% would let a relative and 7.7% would let a close friend use their drugs in the future.
Nearly half of the respondents (46.7%) were still using opioids when they took the survey, and 61.3% claimed to be keeping leftover medication for future use. Slightly more than half of the participants recalled receiving information about safe storage (from packaging or a pharmacist, nurse, or physician) and proper disposal (from packaging, a pharmacist, or print or television news).