Persistent opioid use after hospital discharge in Australia: a systematic review

Abstract

Objective This systematic review identified studies that provided an estimate of persistent opioid use following patient discharge from hospital settings in Australia. Methods A literature search was performed on 5 December 2020, with no date restrictions to identify studies that reported a rate of persistent opioid use following patient discharge from Australian Hospitals. The search strategy combined all terms relating to the themes ‘hospital patients’, ‘prescribing’, ‘opioids’ and ‘Australia’. Studies that dealt solely with cancer, palliative care or addiction medicine were excluded. The databases searched in this review were Embase, PubMed, Scopus, CINAHL, and International Pharmaceutical Abstracts. Studies were assessed for bias using the Newcastle–Ottawa Scale and considered against international literature. Results In total, 13 publications are included for final analysis in this review. Of these, 11 articles relate to post-surgical opioid use. With one exception, studies were of a ‘good’ quality. Methods of data collection in included studies were a mixture of those conducting follow up of patients directly over time and those utilising dispensing databases. Persistent opioid use among surgical patients generally ranged from 3.9 to 10.5% at between 2 and 4 months after discharge. Conclusions How rates of persistent opioid use following hospital encounters in Australia are established, and how long after discharge rates are reported, is heterogeneous. Literature primarily relates to post-surgical patients, with very few studies investigating other settings such as encounters with the emergency department.

Effect of discharge opioid on persistent postoperative opioid use: a retrospective cohort study comparing tapentadol with oxycodone

“…We note that the magnitude of the discharge opioid effect was smaller than for some of these other covariates already established to be −.5 .5 1.5 2.5 3.5 −.5 .5 1.5 2.5 3.5 −.5 .5 1.5 2.5 3.5 −.5 .5 1.5 2. To our knowledge, this is the largest Australian persistent postoperative opioid use study [5], and the first international study that has specifically examined the impact of tapentadol on persistent postoperative opioid use [6]. We were unable to identify the specific surgical specialty for all patients.…”

“…This study is one of the largest and most extensive studies of persistent opioid use following surgery, strengthened by almost complete linkage to patients' 12‐month medication history and 6 months of follow‐up data. To our knowledge, this is the largest Australian persistent postoperative opioid use study [5], and the first international study that has specifically examined the impact of tapentadol on persistent postoperative opioid use [6]. The use of multiple sites in this study, with patients from four large hospitals across three states of Australia, increases generalisability.…”

“…Persistent postoperative opioid use among patients naive to opioids before their operation is typically defined as continuing opioid use in the period ≥ 90 days post-surgery [3,4]. Rates of persistent postoperative opioid use for opioid-naive patients range from 3% to 10% [5], with recent studies noting a drop over time [6]. Reviews have found that patients who are prescribed a new opioid for > 30 days have an increased risk of harms such as prescription opioid use disorder compared with those prescribed opioids for < 30 days [7,8].…”

Design and implementation of an electronic opioid management plan to support consistent communication of opioid analgesia prescribing intentions to patients and general practitioners

“…4 Opioid prescribing requires careful planning due to potentially serious adverse outcomes, including dependence and overdose. [5][6][7][8] To reduce this risk, opioids should be used at the lowest effective dose for the shortest appropriate duration. However, Australian studies show 3.9-10.5% of opioid-na€ ıve patients discharged with opioids after surgery developed persistent use, 8 while 36.5% of ED patients discharged with opioids for low back pain were still taking opioids four weeks after ED presentation.…”

Effect of discharge opioid use on persistent postoperative opioid use

“…Our data also highlighted higher proportions prescribed tapentadol compared with oxycodone in those patients receiving cardiac valve interventions and coronary bypass (21.3% vs. 1.6%, p < 0.001) and spinal surgery (5.3% vs. 4.6%, p < 0.001). As demonstrated in a 2022 systematic review, rates of persistent opioid use after surgery in Australia vary widely from 5.3% after joint arthroplasty to 50.1% after spinal surgery [5]. In the study by Lam et al., surgical specialties were not reliably captured due to inconsistent or non‐specific data.…”