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Should Clinicians Prescribe Opioids to Patients at Hospital Discharge?

New study finds that this practice may worsen the odds of abuse

Nonopioid users who were prescribed painkillers upon hospital discharge were nearly five times more likely to become chronic opioid users after a year than patients who were not prescribed opioids when discharged, a study has found.

University of Colorado Anschutz Medical Campus researchers reviewed nearly 7,000 patients who were prescribed opioids when discharged from the hospital, Forbes reports. None of the patients studied had been prescribed an opioid in the year preceding their hospitalization. Nearly 1,700 of those patients filled a new opioid prescription within 72 hours of leaving the hospital. Clinicians most frequently prescribed two opioids: hydrocodone and oxycodone, the study’s authors learned.

“Patients who had not used an opioid pain medication in the year preceding their hospitalization, who were then prescribed an opioid at hospital discharge, were almost five times more likely to become a chronic opioid user after one year as compared to patients who were not prescribed an opioid at hospital discharge,” said study author Susan Calcaterra, MD, MPH. She said that clinicians should screen patients for abuse risk factors before prescribing opioids to patients being discharged.

“They should consider the etiology of the pain and consider alternative, nonopioid medications when indicated,” Calcaterra said. “When opioids are needed to treat acute, painful conditions, providers should consider prescribing a reduced opioid quantity in patients with risk factors known to be associated with increased risk of abuse and addiction.”

Gathering an accurate patient history could also assist prescribers with deciding on the appropriate treatment for a patient. To do this effectively, Calcaterra believes hospitals should hire more pharmacists to review prescription drug monitoring program (PDMP) databases to ensure patients are not being prescribed opioids by multiple other providers prior to filling opioid prescriptions at hospital discharge.

“Patients should be screened for past or current substance use disorders, heavy alcohol use, and uncontrolled mental health diagnoses prior to prescribing opioids at hospital discharge,” she said.

The researchers didn’t design the study to understand why patients are more likely to become addicted to prescription painkillers after being discharged from the hospital. “One could speculate that while these medications are highly effective in controlling pain, they also cause feelings of euphoria,” Calcaterra said. Once patients are “started on an opioid during the hospitalization and then receive opioids at discharge, they may already be physically and mentally dependent on the medication. Stopping the opioid abruptly could lead to withdrawal symptoms.”

She added: “For these reasons, patients may ask their physicians for additional opioid medication even after their acute issue is resolved. If they are unable to find a medical provider who is willing to prescribing opioids, they may turn to illicit opioid use.”

Source: Forbes, November 24, 2015.

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