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      Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals : Opioids and Opioid-Related Adverse Events

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          Abstract

          Recent studies in the outpatient setting have demonstrated high rates of opioid prescribing and overdose-related deaths. Prescribing practices in hospitalized patients are unexamined.

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          A flood of opioids, a rising tide of deaths.

          Susan Okie (2010)
          Article 0 comments Cited 227 times – based on 0 reviews     Review now
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            Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments.

            Mark J Pletcher, Ralph Gonzales, Mark J Pletcher … (2008)
            National quality improvement initiatives implemented in the late 1990s were followed by substantial increases in opioid prescribing in the United States, but it is unknown whether opioid prescribing for treatment of pain in the emergency department has increased and whether differences in opioid prescribing by race/ethnicity have decreased. To determine whether opioid prescribing in emergency departments has increased, whether non-Hispanic white patients are more likely to receive an opioid than other racial/ethnic groups, and whether differential prescribing by race/ethnicity has diminished since 2000. Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes from 13 years (1993-2005) of the National Hospital Ambulatory Medical Care Survey. Prescription of an opioid analgesic. Pain-related visits accounted for 156 729 of 374 891 (42%) emergency department visits. Opioid prescribing for pain-related visits increased from 23% (95% confidence interval [CI], 21%-24%) in 1993 to 37% (95% CI, 34%-39%) in 2005 (P < .001 for trend), and this trend was more pronounced in 2001-2005 (P = .02). Over all years, white patients with pain were more likely to receive an opioid (31%) than black (23%), Hispanic (24%), or Asian/other patients (28%) (P < .001 for trend), and differences did not diminish over time (P = .44), with opioid prescribing rates of 40% for white patients and 32% for all other patients in 2005. Differential prescribing by race/ethnicity was evident for all types of pain visits, was more pronounced with increasing pain severity, and was detectable for long-bone fracture and nephrolithiasis as well as among children. Statistical adjustment for pain severity and other factors did not substantially attenuate these differences, with white patients remaining significantly more likely to receive an opioid prescription than black patients (adjusted odds ratio, 0.66; 95% CI, 0.62-0.70), Hispanic patients (0.67; 95% CI, 0.63-0.72), and Asian/other patients (0.79; 95% CI, 0.67-0.93). Opioid prescribing for patients making a pain-related visit to the emergency department increased after national quality improvement initiatives in the late 1990s, but differences in opioid prescribing by race/ethnicity have not diminished.
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              Increasing deaths from opioid analgesics in the United States.

              Yongli Lily Xi, L J Paulozzi, Daniel S Budnitz (2006)
              Since 1990, numerous jurisdictions in the United States (US) have reported increases in drug poisoning mortality. During the same time period, the use of opioid analgesics has increased markedly as part of more aggressive pain management. This study documented a dramatic increase in poisoning mortality rates and compared it to sales of opioid analgesics nationwide. Trend analysis of drug poisoning deaths using underlying cause of death and multiple cause of death mortality data from the Centers for Disease Control and Prevention and opioid analgesic sales data from the US Drug Enforcement Administration. Unintentional drug poisoning mortality rates increased on average 5.3% per year from 1979 to 1990 and 18.1% per year from 1990 to 2002. The rapid increase during the 1990s reflects the rising number of deaths attributed to narcotics and unspecified drugs. Between 1999 and 2002, the number of opioid analgesic poisonings on death certificates increased 91.2%, while heroin and cocaine poisonings increased 12.4% and 22.8%, respectively. By 2002, opioid analgesic poisoning was listed in 5528 deaths-more than either heroin or cocaine. The increase in deaths generally matched the increase in sales for each type of opioid. The increase in deaths involving methadone tracked the increase in methadone used as an analgesic rather than methadone used in narcotics treatment programs. A national epidemic of drug poisoning deaths began in the 1990s. Prescriptions for opioid analgesics also increased in this time frame and may have inadvertently contributed to the increases in drug poisoning deaths.
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                Author and article information

                Journal
                Title: Journal of Hospital Medicine
                Abbreviated Title: J. Hosp. Med.
                Publisher: Wiley
                ISSN: 15535592
                Publication date Created: February 2014
                Publication date (Print): February 2014
                Publication date (Electronic): November 13 2013
                Volume: 9
                Issue: 2
                Pages: 73-81
                Affiliations
                [1 ]Division of General Medicine and Primary Care; (Herzig, Cheung, Ngo, Marcantonio), Beth Israel Deaconess Medical Center; Boston Massachusetts
                [2 ]Harvard Medical School (Herzig, Ngo, Marcantonio); Boston Massachusetts
                [3 ]Department of Internal Medicine; Medicine Institute; Cleveland Clinic Cleveland Ohio
                [4 ]Division of Gerontology (Marcantonio); Beth Israel Deaconess Medical Center; Boston Massachusetts
                Article
                DOI: 10.1002/jhm.2102
                PubMed ID: 24227700
                SO-VID: 8717eb69-33e4-4450-b3fd-6a613462ea1b
                Copyright © © 2013
                License:

                http://doi.wiley.com/10.1002/tdm_license_1

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