Certain Drugs May Increase the Risk of Opioid-Use Disorder, Even in Opioid-Naïve Patients

Studies have suggested there is an association between inpatient opioid use and increased adverse clinical outcomes, mortality, and cost of hospitalization. There are also concerns that opioid use in the hospital may contribute to subsequent opioid-use disorder (OUD) after discharge.

A study evaluated medication-related risk factors associated with developing opioid-related adverse events and chronic opioid use following inpatient opioid use in an opioid-naïve population. The researchers found that providers need to be aware of patient characteristics and medications associated with increased risk of OUD to develop strategies to mitigate subsequent OUD.

The results of the study were presented during AMCP Nexus 2020 Virtual in a poster presentation titled “Evaluating medication-related risk factors for developing opioid-use disorder post-hospitalization.”

Researchers linked outpatient and inpatient encounter data from a large integrated health plan of members aged 14 years or older who did not have any opioid claims 12 months prior to inpatient opioid use. Researchers compared patients who developed OUD with those who did not based on specific medications using students t-test. They also assessed an association between risk factors and OUD using multivariate logistic regression.

The cohort included 23,352 opioid-naïve patients who were prescribed inpatient opioids between Sept. 2014 and July 2017; 3% of patients (n=781) developed OUD by 12 months post-discharge.

Patients who developed OUD were younger (mean age, 42.35 vs. 56.40 years; P<0.0001) and had a lower mean Charlson Comorbidity Index score (1.85 vs. 2.33; P<0.0001) compared with patients who did not develop OUD.

Patients who developed OUD had statistically significant higher usage (defined as dose, days’ supply, and number of prescriptions) of benzodiazepines, gabapentin, and skeletal muscle relaxants prior to admission; however, only gabapentin remained statistically significant in a multivariate logistic regression analysis when controlling for patient demographics, diagnosis, family, and area characteristics.

Patients with OUD also had higher daily morphine equivalent doses at 30 days (4.8 vs. 3.2; P=0.037), 60 days (3.9 vs 1.5; P=0.0007), and 12 months (2.3 vs. 1.3; P=0.003) post-discharge.

Peasah S, Huang Y, Swart S, Neilson L, Good CB. Evaluating medication-related risk factors for developing opioid-use disorder post-hospitalization. Poster F5. AMCP Nexus 2020 Virtual.