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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 
•  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.

•  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.
•  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.

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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