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5108
Inpatient Prescribing Patterns of Long-Acting and Extended Release Opioids
Session: MP-01b
Thurs, April 19, 8-9:45 am
Uris (Shubert Complex), 6th floor

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Inpatient Prescriber Patterns of Long-Acting and Extended-Release Opioids

Mojica J1, Shah N1, Torjman MC2, Viscusi E2
Thomas Jefferson University Hospital, Department of Anesthesiology, Philadelphia, PA1
Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA2 
 
 
Introduction:
•  Long-acting and extended-release (LA/ER) opioids are potent analgesic medications that have been FDA approved for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
•  LA/ ER opioid formulations have contributed to the opioid epidemic and has led the FDA to restrict the indications for LA/ER opioid analgesics.1
•  LA/ER opioids should not be considered in patients with acute pain, post-operative pain, or in those that are opioid naïve.1 Based on these FDA restrictions, these medications should rarely be initiated in the inpatient setting. 

Purpose of the study: To evaluate compliance with the revised FDA labels as an institutional quality and safety review.

Results:
•  5,989 (31.8%) patients were initiated on a LA/ER opioid during their hospitalization (Figure 1.0).
•  Of these patients, 3,554 (59.4%) patients were opioid naïve (Table 1.0).
•  There has been a statistically significant decrease in the number of patients initiated on LA/ER opioid therapy since 2011 (Figure 2.0).
•  The most commonly prescribed opioids can be seen in Figure 3.0.
 
Discussion:
•  Inpatient pain management is a quality measure that has financial implications and may compel providers to prescribe opioids in the inpatient hospital setting.2
•  The results suggest prescribers have been slow to adapt the revised indications for LA/ER opioids.
•  In the context of the opioid crisis and the unique risk of ER/LA opioids, there is little evidence to support the initiation of these drugs in the postoperative period for acute pain. 
 
Future Directions:
•  Identification of hospital services (medicine vs. surgical) that are most likely to initiate LA/ER opioids.
•  Promotion of multi-modal and collaborative efforts to reduce opioid prescribing.
•  Explore the possibility of restricting inpatient prescribing of LA/ER opioids.
 
Refences:

1.  FDA blueprint for prescriber education for extended-release and long-acting opioid analgesics. Available at: https://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/uc.... Accessed December 12, 2017.

2.  Gupta A, Daigle S, Mojica J, Hurley RW. Patient perception of pain care in hospitals in the united states. J Pain Res 2009;2:157-64.

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