An evaluation of discharge opioid prescribing practices in a burn population

Opioids are the cornerstone of pain treatment in burn patients. Undertreatment of pain has been associated with psychological sequela. However, prescription opioids have been increasingly associated with adverse drug effects. Safe opioid prescribing practices have been established in other populations. The purpose of this study was to explore postdischarge prescribing practices in a regional burn center. A retrospective review of hospital and discharge records of patients ≥18 years admitted to the burn center from December 2009 to June 2012 was performed. Charts were reviewed for demographic, burn, hospital treatment, and follow-up data. Pain scores and opioid needs were assessed 24 and 48 hours before discharge. Discharge opioid prescriptions and opioid refills were recorded. Pearson correlation and multiple linear regression was used to assess variables related to discharge opioid amounts. Jonckheere-Terpstra nonparametric test was used to identify the variables associated with the number of refills of opioid analgesia. Of the 140 patients, 120 (85.7%) were discharged on opioids. The median daily prescribed amount was 114 (interquartile range, 90-180) mg morphine equivalents (ME) for a median total duration of 6 (interquartile range: 4-10) days. Age (P < .0001), male sex (P = .024), and total mg ME before discharge (P < .0001) were independently associated with the amount of opioids prescribed at discharge. The number of refills was significantly associated with the average pain within 48 hours before discharge (P = .005) and with 24 hour predischarge mg ME (P = .006). By 14 days, 114 (84.3%) patients were still being seen in clinic and 127 (90.0%) were no longer taking opioids. The treatment of burn pain requires large amounts of opioids. Continued opioid therapy is necessary as the patients transition to the out-patient setting. This study identified several areas that could be modified to align with safer opioid prescribing practices, including lowering daily amount of prescribed opioids, prescribing only short-acting opioids, and providing patient opioid education. Future studies should focus on the adverse effects of opioid use in burn patients.