A study led by investigators at Harvard Medical School has analyzed the pharmacy claims of 623,957 Medicare beneficiaries who were hospitalized in 2011. The results, published in JAMA Internal Medicine, showed that 14.9% of the hospitalized beneficiaries filled a prescription for an opioid within one week after being discharged. Of those who filled the first prescription, 42.5% had another pharmacy claim for an opioid painkiller at least 90 days later.
“Presumably they were prescribed [an opioid] and continued on it because of some sort of chronic pain,” lead author Dr. Anupam Jena told Kaiser Health News. Still, there are many ways to treat pain, Jena noted, and hospitals are supposed to look at other approaches.
In 2013, nearly 44,000 people died from drug overdoses, including more than 16,000 from opioid painkillers such as hydrocodone and morphine, according to the Centers for Disease Control and Prevention. Drug overdoses involving opioids nearly quadrupled between 1999 and 2013.
As part of a federal initiative to improve opioid prescribing practices, last week the Centers for Medicare and Medicaid Services proposed to stop incorporating patient satisfaction responses regarding pain management into hospital Medicare payment calculations. Some physicians have said that they feel pressure to prescribe opioids in order to get good scores.
The JAMA Internal Medicine study found that, across 2,512 hospitals, the average adjusted rate of new opioid use within seven days after hospitalization was 15%. In addition, hospitals that were ranked higher by patients for inpatient pain control had modestly higher rates of opioid use after discharge.
“For patients who are similar across a broad range of characteristics … there appears to be a large range in the propensity of hospitals to prescribe opioids,” Jena said. “The variation is alarming because it means some hospitals are doing it too much and some too little.”
More research is needed to determine what the appropriate opioid prescribing standards should be, he said.