Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients

Krancevich, Niki M; Belfer, Julie J.; Draper, Heather; Schmidt, Kyle J.

doi:10.1177/10600280211016856

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…In total, 12 studies examined the use of analgesics in the posthospital discharge period (online supplemental file S3, table 4). 5 17 20 47–55 Analgesics examined included simple analgesics such as paracetamol alongside weak and strong opioids. Five studies examined the use of analgesia at hospital discharge,47 48 50 52 55 three studies were based in the ICU follow-up setting5 17 20 and six studies examined analgesics longitudinally across the critical care recovery period (up to 24 months following discharge 48 49 51 53–55.…”

Section: Resultsmentioning

confidence: 99%

Medication-related problems in critical care survivors: a systematic review

et al. 2023

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ObjectivesThere are numerous, often single centre discussions of assorted medication-related problems after hospital discharge in patients who survive critical illness. However, there has been little synthesis of the incidence of medication-related problems, the classes of medications most often studied, the factors that are associated with greater patient risk of such problems or interventions that can prevent them.MethodsWe undertook a systematic review to understand medication management and medication problems in critical care survivors in the hospital discharge period. We searched OVID Medline, Embase, PsychINFO, CINAHL and the Cochrane database (2001–2022). Two reviewers independently screened publications to identify studies that examined medication management at hospital discharge or thereafter in critical care survivors. We included randomised and non-randomised studies. We extracted data independently and in duplicate. Data extracted included medication type, medication-related problems and frequency of medication issues, alongside demographics such as study setting. Cohort study quality was assessed using the Newcastle Ottowa Score checklist. Data were analysed across medication categories.ResultsThe database search initially retrieved 1180 studies; following the removal of duplicates and studies which did not fit the inclusion criteria, 47 papers were included. The quality of studies included varied. The outcomes measured and the timepoints at which data were captured also varied, which impacted the quality of data synthesis. Across the studies included, we found that as many as 80% of critically ill patients experienced medication-related problems in the posthospital discharge period. These issues included inappropriate continuation of newly prescribed drugs such as antipsychotics, gastrointestinal prophylaxis and analgesic medications, as well as inappropriate discontinuation of chronic disease medications, such as secondary prevention cardiac drugs.ConclusionsFollowing critical illness, a high proportion of patients experience problems with their medications. These changes were present across multiple health systems. Further research is required to understand optimal medicine management across the full recovery trajectory of critical illness.PROSPERO registration numberCRD42021255975.

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Section: Resultsmentioning

confidence: 99%

Medication-related problems in critical care survivors: a systematic review

et al. 2023

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“…Few studies evaluating persistent opioid use after critical illness reported ICU opioid doses (23)(24)(25); among opioid-naïve patients, Krancevich et al (23) and Witcraft et al (24) found no association between ICU opioid dose and persistent opioid use), and Tollinche et al (25) observed that patients who received opioids in the ICU were less likely to receive an opioid prescription at discharge. Witcraft et al (24) found that intubation and hospital (but not ICU) opioid dose were associated with continuing opioids at discharge.…”

Section: Discussionmentioning

confidence: 99%

“…Yaffe ( 10 ), Wang et al ( 13 ), and Witcraft et al ( 24 ) reported that ICU LOS was not associated with persistent opioid use; in contrast, Wunsch et al ( 17 ) reported that ICU stays longer than 7 days were associated with greater risk of persistent opioid use. Krancevich et al ( 23 ) and Tollinche et al ( 25 ) reported that LOS after transfer to a non-ICU bed was associated with persistent opioid use, as was total hospital LOS for Witcraft et al ( 24 ). Due to collinearity, LOS data were not included in our multivariable model, but opioid-free days were associated with a reduced risk of persistent opioid fills, suggesting more aggressive opioid weaning, rather than limiting daily dose, may be a promising method to reduce persistent opioid use, but this has not been tested.…”

Section: Discussionmentioning

confidence: 99%

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

Wampole

McKenna

Riker

et al. 2022

Critical Care Explorations

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The association between opioid therapy during critical illness and persistent opioid use after discharge is understudied relative to ICU opioid exposure and modifiable risk factors. Our objectives were to compare persistent opioid use after discharge among patients with and without chronic opioid use prior to admission (OPTA) and identify risk factors associated with persistent use. DESIGN:Retrospective cohort study. SETTING: Medical, trauma/surgical, or neurologic ICU at an academic hospital. PARTICIPANTS: Adult patients surviving hospital admission. INTERVENTIONS:Opioid use during the ICU and post-ICU stays. MEASUREMENTS AND MAIN RESULTS:The primary outcome was persistent opioid use accounting for greater than 70% of days 4-6 months after discharge. Among 2,975 included patients, 257 (8.6%) were classified as OPTA, and 305 (10.2%) persistently filled opioid prescriptions, including 186/257 (72%) OPTA and 119/2,718 (4.4%) with no chronic opioid fills prior to admission. Among all patients, OPTA was strongly associated with persistent opioid use (odds ratio, 57.2 [95% CI,). Multivariable logistic regression revealed that male sex, surgical procedure, and ICU opioid-free days were associated with reduced persistent opioid use for OPTA patients. Age and ICU opioid-free days were associated with reduced persistent opioid use for non-OPTA patients. Total ICU opioid dose and dose per day of ICU exposure were not associated with persistent use for either group. CONCLUSIONS:In this mixed cohort of ICU patients, 10.2% persistently filled opioid prescriptions 4-6 months after discharge. Although ICU opioid doses were not associated with persistent use, duration of ICU opioid administration is a modifiable risk factor that may reduce persistent opioid use after critical illness.

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“…Opioid prescribing during inpatient and perioperative care is associated with long‐term opioid‐related harms 1–4 . Although focus on prescribing of opioid and benzodiazepines has recently increased, little is known regarding prescribing patterns following admission for COVID‐19 3,5 .…”

Section: Introductionmentioning

confidence: 99%

“…Opioid prescribing during inpatient and perioperative care is associated with long‐term opioid‐related harms. 1 , 2 , 3 , 4 Although focus on prescribing of opioid and benzodiazepines has recently increased, little is known regarding prescribing patterns following admission for COVID‐19. 3 , 5 COVID‐19 has resulted in the hospitalization of millions of Americans, many of whom are without prior health conditions, and are opioid‐ and benzodiazepine‐naïve.…”

Section: Introductionmentioning

confidence: 99%

Opioid and benzodiazepine prescribing after COVID‐19 hospitalization

Delaney

Bicket

et al. 2022

Journal of Hospital Medicine

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Opioid and benzodiazepine prescribing after COVID‐19 hospitalization is not well understood. We aimed to characterize opioid and benzodiazepine prescribing among naïve patients hospitalized for COVID and to identify the risk factors associated with a new prescription at discharge. In this retrospective study of patients across 39 Michigan hospitals from March to November 2020, we identified 857 opioid‐ and benzodiazepine‐naïve patients admitted with COVID‐19 not requiring mechanical ventilation. Of these, 22% received opioids, 13% received benzodiazepines, and 6% received both during the hospitalization. At discharge, 8% received an opioid prescription, and 3% received a benzodiazepine prescription. After multivariable adjustment, receipt of an opioid or benzodiazepine prescription at discharge was associated with the length of inpatient opioid or benzodiazepine exposure. These findings suggest that hospitalization represents a risk of opioid or benzodiazepine initiation among naïve patients, and judicious prescribing should be considered to prevent opioid‐related harms.

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Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients

Cited by 9 publications

References 16 publications

Medication-related problems in critical care survivors: a systematic review

Medication-related problems in critical care survivors: a systematic review

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

Opioid and benzodiazepine prescribing after COVID‐19 hospitalization

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