Opioid Prescribing Patterns Before, During, and After Critical Illness: An Observational Study

Area of Science:

• Critical Care Medicine
• Pharmacology
• Health Services Research

Background:

• Persistent opioid use after critical illness is a growing concern.
• Understanding risk factors, especially prior opioid use, is crucial for intervention.

Purpose of the Study:

• To compare persistent opioid use post-discharge between patients with and without chronic opioid use prior to admission (OPTA).
• To identify risk factors associated with persistent opioid use after ICU admission.

Main Methods:

• Retrospective cohort study of adult ICU survivors at an academic hospital.
• Analyzed opioid use during ICU and post-ICU stays.
• Defined persistent opioid use as filling prescriptions for >70% of days 4-6 months post-discharge.

Main Results:

• 10.2% of patients persistently filled opioid prescriptions post-discharge.
• Patients with prior opioid use (OPTA) had a significantly higher rate (72%) of persistent use compared to non-OPTA patients (4.4%).
• Male sex, surgical procedures, and ICU opioid-free days were associated with reduced persistent use in OPTA patients; age and ICU opioid-free days in non-OPTA patients. ICU opioid dose was not associated with persistent use.

Conclusions:

• Prior opioid use is a strong predictor of persistent opioid use after critical illness.
• Duration of ICU opioid administration, not dose, is a modifiable risk factor to reduce long-term opioid use.