Elderly patients who were prescribed opiates had longer hospital stays, on average, than those who were not.
In late 2017, the Department of Health and Human Services declared the nation’s opioid crisis a “public health emergency.” The problem has been building for over a decade, spurred by sharp increases in opioid prescriptions, which are commonly used to treat both short-term and chronic pain.
In 2015, the amount of opioids prescribed per capita was about three times as high as in 1999, according to data from the Centers for Disease Control and Prevention (CDC). As Americans receive prescriptions for these habit-forming painkillers, including the commonly prescribed Vicodin, Percocet and OxyContin, at higher doses and for longer durations, the prevalence of addiction and overdose also have grown. The CDC recorded over 33,000 opioid overdose deaths in 2015 alone.
As physicians grapple with their role in this national crisis, they must consider the risks and benefits of prescribing opiates. CDC guidelines suggest that opioids should be used as a last resort, and that doctors instead offer non-steroidal anti-inflammatory pain medications like ibuprofen as a first defense. A 2014 study published in the American Journal of Emergency Medicine found that broader use of opioids in emergency rooms did not reduce the prevalence of pain among patients. And new research casts further doubt on the clinical relevance of opiate prescription, as researchers examine links between opiate use and negative recovery outcomes for elderly patients who have been hospitalized.
An academic study worth reading: “Opiate Prescribing in Hospitalized Older Adults: Patterns and Outcomes,” published in the Journal of the American Geriatrics Society, October 2017.
About the study: Researchers at Northwell Health, an integrated health system in New York, analyzed the records of 9,245 patients aged 65 and older who were hospitalized between September 22, 2014 and October 3, 2015. They divided patients into three groups — those who did not receive opiates, those who were using them when they were admitted and those who were prescribed opiates during their stay. The researchers looked at whether exposure to opiates affected recovery outcomes, including the patient’s length of stay and readmission status within 30 days of discharge.
- Patients who did not receive opiates spent less time in the hospital. They were hospitalized an average of 5.2 days compared to an average of 6.8 days for patients who were using opiates at the time of admission and 7.7 days for those prescribed opiates during their stay.
- Those who did not receive opiates also were less likely to be readmitted to the hospital within 30 days. Their readmission rate was 19.6 percent, compared with 25 percent and 22.3 percent for prior and new opiate users, respectively.
- Patients who did not use opiates were more likely to be discharged to their homes than to skilled nursing facilities. Nearly 89 percent of these patients were allowed to go home, compared with about 83 percent of patients from the other two groups.
- The researchers found an association between prior or in-hospital opiate use and certain health care practices linked with poor recovery outcomes.
- There were no significant differences in opiate exposure by race, ethnicity, or sex.
- A 2017 study published by the National Bureau of Economic Research, “Addressing the Opioid Epidemic: Is There a Role for Physician Education?” finds that doctors who attended top-ranked medical schools prescribed fewer opioids than those who attended worse-ranked institutions.
- A 2016 study published in the Journal of General Internal Medicine, “Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use,” highlights how patients who receive opioid prescriptions when they leave the hospital are more likely to develop a habit of chronic opioid use.
- A 2016 study published in the Journal of the American Medical Association, “Prescription of Long-Acting Opioids and Mortality in Patients with Chronic Noncancer Pain,” finds significant associations between these drugs and the risk of death, including from non-overdose causes. .
- A 2016 review of the academic literature on opioid misuse in older adults, published in the American Journal of Geriatric Psychiatry, provides broad context on the issue.
- A 2016 study published in JAMA Internal Medicine, “Hospital Prescribing of Opioids to Medicare Beneficiaries,” indicates that nearly 15 percent of Medicare patients filled a new opioid prescription after being discharged from a hospital.