New Guidelines Issued for Opioid Use in Hospital Inpatients
More than half of non-surgical inpatients receive opioids for pain, and hospitalization has been shown to be a factor in long-term opioid use in millions of adults each year. That's why new guidelines were developed on safe use of opioid in hospitalized patients. Here is what the new document recommends.
BOSTON – More than half of all hospitalized patients receive at least one dose of an opioid for acute pain during their stay, even if they haven't undergone surgery. Yet, few pain guidelines focus on use of narcotics in inpatients who are not post-surgical.
To remedy that, a national working group led by a Beth Israel Deaconess Medical Center researcher has developed a Consensus Statement on safe prescribing of opioids for hospitalized adults with acute pain.
The 16 recommendations were published recently in the Journal of Hospital Medicine andoffer suggestions on when and how to use opioids, as opposed to other pain management methods. The objective is to improve the safety of opioid use for non-cancer pain during the hospital stay, while also helping to manage opioids use at and after discharge.
"Hospital-based clinicians frequently treat patients with acute pain, and although opioids may sometimes be beneficial in this setting, they do carry the risk of adverse events including inadvertent overdose and physical dependence," explained lead author Shoshana J. Herzig, MD, MPH, Director of Hospital Medicine Research at Beth Israel Deaconess. "This guidance is intended to help clinicians practicing medicine in the inpatient setting balance the benefits of opioid treatment against its risks."
One of the key recommendations is that opioids only be used for severe pain or for moderate pain when patients haven't responded to or are unable to use non-opioid pain medications, such as acetaminophen or ibuprofen.
"The risk-to-benefit ratio of opioid and non-opioid therapy should be considered for all patients in determining the best initial management strategy," Herzig pointed out. "Clinicians tend to underestimate the benefit of non-opioid analgesics and overestimate the risks, while for opioids they overestimate the benefits and underestimate the risks. For most painful conditions, acetaminophen and non-steroidal anti-inflammatory drugs have been shown to be equally or more effective with less risk of harm than opioids."
Other important recommendations include:
- prescribing the lowest effective doses for the shortest duration possible,
- using immediate-release opioid formulations and
- giving the drugs orally whenever possible.
Study authors note that those practices avoid prescribing long-acting opioids or administrating them intravenously, which have been shown to have greater risk of overdose and addiction.
The document was developed as part of a nationwide working group convened by the Society of Hospital Medicine, which developed them following a systematic review of nearly 1,000 relevant opioid-prescribing guidelines.
Checking the prescription drug monitoring program when prescribing opioids, developing goals for patient recovery, and educating patients regarding the risks and side effects of opioid therapy are all recommended as part of the guidelines. Additional recommendations include using an opioid-dose conversion guide, avoidance of co-administration of parenteral and oral opioids, and using caution when co-prescribing opioids with other central nervous system depressants.
"Guidelines, based largely on expert opinion, recommend judicious prescribing of opioids for severe, acute pain," study authors conclude. "Future work should assess the implications of these recommendations on hospital-based pain management."