Chronic Opioid Therapy Common among Hospitalized Veterans, Associated with Increased Risk of Death and Re-Admission
BACKGROUND:
Recent trends show a marked increase in outpatient use of chronic opioid therapy (COT) for chronic non-cancer pain, without a decrease in this type of pain, which raises concerns about the efficacy and risk-to-benefit ratio of opioids in this population. Opioid use also has been linked to increased emergency room use and emergency hospitalization, but an association between opioid use and inpatient metrics (e.g., mortality, readmission) has not been explored. This observational study sought to determine the prevalence of prior COT among hospitalized medical patients, in addition to examining characteristics associated with inpatients that had previous opioid therapy compared to those with no opioid therapy prior to hospital admission. Using VA administrative data, investigators identified 122,794 Veterans with acute medical admissions to one of 129 VAMCs during FY09 to FY11. Patient variables assessed in this study included demographics, rural vs. urban residence, hospital location, and overall comorbidity using 10 selected conditions based on high prevalence among hospitalized Veterans. Conditions included: chronic pain, complicated diabetes, renal disease, dementia, mental health (i.e., anxiety disorders, substance use disorders), PTSD, congestive heart failure, chronic obstructive pulmonary disease (COPD), non-metastatic cancer, and metastatic solid tumor.
FINDINGS:
- COT is common among hospitalized Veterans; moreover, occasional and chronic opioid use was associated with increased risk of hospital readmission and COT was associated with increased risk of death.
- Nearly 1 in 4 hospitalized Veterans had current or recent COT at the time of hospital admission for non-surgical conditions, and nearly half had been prescribed any opioids. Among the 122,794 Veterans in this study, 31,802 (26%) had received COT in the prior 6 months, and 24,093 (20%) had occasional opioid therapy.
- Among Veterans in the COT group, 11% received a 90-day supply, 32% received 91-179 days, and 57% received >180-day supply of opioids in the prior 6 months.
- Among hospitalized Veterans, those who received COT in the 6 months prior to hospital admission tended to be younger, more often female, white, have a rural residence, and live in the South or West.
- Diagnoses more common in Veterans with COT included COPD, complicated diabetes, PTSD, and other mental health disorders.
LIMITATIONS:
- The definition of opioid exposure depended upon pharmacy dispensing records, thus investigators were unable to confirm whether or not Veterans were taking medications as prescribed.
- More research is needed to clarify whether and how COT increases risk of death or if it is simply a marker for other factors (for example, inappropriate prescribing) that affect mortality.
AUTHOR/FUNDING INFORMATION:
All authors are part of HSR&D's Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City, IA. Dr. Mosher is supported by a VA Quality Scholars Fellowship.
Mosher H, Jiang L, Vaughan Sarrazin M, et al. Prevalence and Characteristics of Hospitalized Adults on Chronic Opioid Therapy. Journal of Hospital Medicine December 6, 2013;e-pub ahead of print.
