title: Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use.
abstract: BACKGROUND
  Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use.
  
  
  OBJECTIVE
  We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital.
  
  
  METHODS
  Chronic opioid use 1 year post discharge.
  
  
  RESULTS
  Twenty-five percent of opioid naïve patients (n = 1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3% versus 3.5%, p < 0.001), acute pain (2.7% versus 1.0 %, p < 0.001), chronic pain at admission (12.1% versus 3.3%, p < 0.001) or surgery during their hospitalization (65.1% versus 18.4%, p < 0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7% versus 20.7%, p < 0.001) and mental health disorders (23.9% versus 31.4%, p < 0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1% versus 1.3%, p < 0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR = 4.90, 95% CI 3.22-7.45) and greater subsequent opioid refills (AOR = 2.67, 95% CI 2.29-3.13) 1 year post discharge compared to no opioid receipt.
  
  
  CONCLUSIONS
  Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA. susan.calcaterra@ucdenver.edu.|Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA. susan.calcaterra@ucdenver.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Calcaterra
authors.affiliation: School of Medicine, Undergraduate Medical Education, University of Colorado Denver School of Medicine, Aurora, CO, USA.
authors.forename: Traci E
authors.initials: TE
authors.lastname: Yamashita
authors.affiliation: Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Sung-Joon
authors.initials: SJ
authors.lastname: Min
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Keniston
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA.|VA Eastern Colorado Health Care System, Denver, CO, USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Frank
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA.|Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology; D003120:Colorado / Q000453:epidemiology; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000209:etiology*; D010351:Patient Discharge; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: hospital medicine; pain; substance abuse