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An evaluation of opioid use during acute hospital admissions

25 June 2020
Professional
02 June 2020
Volume 29 · Issue 12

Abstract

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

Opioid medicines are usually prescribed to treat moderate to severe pain. They are effective for managing acute pain from either injury or illness and pain at the end of life, and a small proportion of people may obtain good pain relief with opioids in the long term, if the dose can be kept low and especially if their use is intermittent (Royal College of Anaesthetists (RCoA), 2018). However, there is little evidence that they have longer term benefits. There remains limited information regarding the transition from acute prescribing to chronic opioid use.

Effective pain management is a cornerstone of postoperative care and is frequently reliant on opioid therapy; however, after minor surgical procedures patients do not take many of the opioids prescribed to them and less is known of opioid use following trauma or major surgery (Bartels et al, 2016). Prescription opioid use is defined as the use of prescribed opioids to treat pain in the way intended by the prescriber (Whiteside et al, 2016), but repeated use can lead to dependence and tolerance.

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Opioid
Acute pain
Chronic non-cancer pain
Opioid recommendations
Postoperative care