It's a common scenario: Someone checks into a hospital for surgery or an illness and leaves with a prescription for an opioid painkiller, opening the door to long-term use and dependence. A recent study examined this pattern and found the prescriptions are used and renewed more often than you might imagine.
Researchers analyzed the pharmacy claims of a random sample of more than 623,000 Medicare beneficiaries who were hospitalized in 2011. They only included people who did not have a prescription claim for opioids for at least 60 days before being hospitalized.
The results, first published online in JAMA Internal Medicine in June, showed that 14.9 percent of the hospitalized beneficiaries filled a prescription for an opioid within a week after being discharged. Of those who filled the first prescription, 42.5 percent had another pharmacy claim for an opioid painkiller at least 90 days later.
"Presumably they were prescribed it and continued on it because of some sort of chronic pain," said Dr. Anupam Jena, associate professor of health care policy at Harvard Medical School and the study's lead author. Still, there are many ways to treat pain, Jena noted, and hospitals are supposed to look at other approaches.
In 2013, nearly 44,000 people died from drug overdoses, including more than 16,000 from opioid painkillers such as hydrocodone and morphine, according to the Centers for Disease Control and Prevention. Drug overdoses involving opioids nearly quadrupled between 1999 and 2013.
As part of a federal initiative to improve opioid prescribing practices, last week the Centers for Medicare and Medicaid Services proposed to stop incorporating patient satisfaction responses regarding pain management into hospital Medicare payment calculations. Some physicians have said they feel pressure to prescribe opioids in order to get good scores.
The JAMA Internal Medicine study found significant variations in the rate of new opioid use by Medicare beneficiaries across hospitals, from 10 percent on the low end to 20 percent on the high end.
In addition, hospitals that were ranked higher by patients for inpatient pain control had modestly higher rates of opioid use after discharge.
"For patients who are similar across a broad range of characteristics ... there appears to be a large range in the propensity of hospitals to prescribe opioids," Jena said. "The variation is alarming because it means some hospitals are doing it too much and some too little." More research is needed to determine what the appropriate opioid prescribing standards should be, he said.
