Predictors of Long-Term Opioid Use After Opioid Initiation at Discharge From Medical and Surgical Hospitalizations
Opioid analgesics may be initiated following surgical and medical hospitalization or in ambulatory settings; rates of subsequent long-term opioid (LTO) use have not been directly compared. This retrospective cohort study of the Veterans Health Administration (VHA) included all patients receiving a new outpatient opioid prescription from a VHA provider in fiscal year 2011. If a new outpatient prescription was filled within 2 days following hospital discharge, the initiation was considered a discharge prescription. LTO use was defined as an episode of continuous opioid supply lasting a minimum of 90 days and beginning within 30 days of the initial prescription. We performed bivariate and multivariate analyses to identify the factors associated with LTO use following surgical and medical discharges. Following incident prescription, 5.3% of discharged surgical patients, 15.2% of discharged medical patients, and 19.3% of outpatient opioid initiators received opioids long term. Medical and surgical patients differed; surgical patients were more likely to receive shorter prescription durations. Predictors of LTO use were similar in medical and surgical patients; the most robust predictor in both groups was the number of days’ supply of the initial prescription (odds ratio [OR] = 1.24 and 95% confidence interval [CI], 1.12-1.37 for 8-14 days; OR = 1.56 and 95% CI, 1.39-1.76 for 15-29 days; and OR = 2.59 and 95% CI, 2.35-2.86 for >30 days) compared with the reference group receiving ≤7days. Rates of subsequent LTO use are higher among discharged medical patients than among surgical patients. Characteristics of opioid prescribing within the initial 30 days, including initial dose and days prescribed, were strongly associated with LTO use.
CONCLUSION
The initiation of LTO use at discharge is more common in veterans who are discharged from medical than surgical hospitalizations, likely reflecting differences in the patient population, pain conditions, and discharge prescribing decisions. While patient characteristics are associated with LTO use, the strongest associations are with increasing index dose and days’ supply; both represent potentially modifiable prescriber behaviors. These findings support policy changes and other efforts to minimize dose and days supplied when short-term use is intended as a means to address the current opioid epidemic.
Acknowledgments
The work reported here was supported by the Department of Veterans Affairs Office of Academic Affiliations and Office of Research and Development (Dr. Mosher and Dr. Hofmeyer), and Health Services Research and Development Service (HSR&D) through the Comprehensive Access and Delivery Research and Evaluation Center (CIN 13-412) and a Career Development Award (CDA 10-017; Dr. Lund).
Disclosures
The authors report no conflict of interest in regard to this study. The authors had full access to and take full responsibility for the integrity of the data. All analyses were conducted by using SAS version 9.2 (SAS Institute Inc, Cary, NC). This manuscript is not under review elsewhere, and there is no prior publication of the manuscript contents. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The study was approved by the University of Iowa Institutional Review Board and the Iowa City Healthcare System Research and Development Committee.
