Improving the Safety of Opioid Use for Acute Noncancer Pain in Hospitalized Adults: A Consensus Statement From the Society of Hospital Medicine

Abstract

Hospital-based clinicians frequently treat acute, non-cancer pain. While opioids may be beneficial in this setting, benefits must be balanced with risks of adverse events including inadvertent overdose and prolonged opioid use, physical dependence, or development of opioid use disorder. In an era of epidemic opioid use and related harms, the Society of Hospital Medicine convened a working group to develop a consensus statement on opioid use for adults hospitalized with acute, non-cancer pain, outside of the palliative, end-of-life, and intensive care settings. The guidance is intended for clinicians practicing medicine in the inpatient setting (e.g., hospitalists, primary care physicians, family physicians, nurse practitioners, and physician assistants). To develop the Consensus Statement, the working group conducted a systematic review of relevant guidelines, composed a draft Statement based on extracted recommendations, and obtained feedback from external experts in hospital-based opioid prescribing, SHM members, the SHM Patient-Family Advisory Council, other professional societies, and peer-reviewers. The iterative development process resulted in a final Consensus Statement consisting of 16 recommendations covering 1) whether to use opioids in the hospital, 2) how to improve the safety of opioid use during hospitalization, and 3) how to improve the safety of opioid prescribing at hospital discharge. As most guideline recommendations from which the Consensus Statement was derived were based on expert opinion alone, the working group identified key issues for future research to support evidence-based practice.

Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest

“…[38][39][40] Providers should also look for opportunities to have discussions with patients and their families about communicating levels of pain and appropriate expectations of pain management during hospitalization. 27,41 Second, older teenagers had 3 to 4 times higher odds of receiving an opioid than younger children (ages 10 to 12) and received more opioids than younger children during the first 48 hours of hospitalization. This may be attributable to physical size differences, as weight increases as children age, but weight only partially explained differences in opioid administration.…”

Opioid Therapy in Acute and Chronic Pain

“…Opioids are not the initial treatment of choice for outpatients. The risks and benefits of opioid use should always be weighed when initiating therapy and when deciding whether to pursue, modify, or continue treatment, and opioids should only be used when they are expected to be effective . Because of the current opioid crisis and concern about development of opioid use disorder, patients are at risk for undertreatment or being denied treatment of pain.…”

“…The risks and benefits of opioid use should always be weighed when initiating therapy and when deciding whether to pursue, modify, or continue treatment, and opioids should only be used when they are expected to be effective. 17 Because of the current opioid crisis and concern about development of opioid use disorder, patients are at risk for undertreatment or being denied treatment of pain. Some specific populations (eg, the elderly 18 , nonwhite minorities 19 ) may be even more likely to have inadequate treatment of pain.…”

“…This may be a 3-to 5-day supply for acute pain. 17 Patients are considered opioid naive if they have used a continuous dose of opioid for fewer than 7 days (or intermittent opioids). 5,20 According to the US Food and Drug Administration, opioid-tolerant patients are those who have received a daily dose of greater than or equal to oral morphine 60 mg, oral oxymorphone 25 mg, oral oxycodone 30 mg, oral hydromorphone 8 mg, oral hydrocodone 60 mg, or transdermal fentanyl 25 μg/h for at least 7 days.…”

Opioids in the treatment of non-specific acute and chronic pain

“…Для пацієнтів, які не отримують опіоїди, слід призначати мінімальну кількість опіоїдів, які передбачаються необхідними для очікуваної важкості та тривалості болю. Це може бути від 3 до 5 днів для гострого болю [17]. Пацієнти вважаються опіоїдозалежними, якщо вони використовували безперервну дозу опіоїдів протягом менш ніж 7 днів (або періодичні опіоїди) [5,20].…”