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.
• 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.