Persistent opioid use after hospital discharge in Australia: a systematic review
Benita Suckling
A B * , Champika Pattullo C , Shania Liu A D , Prudence James E , Peter Donovan C , Asad Patanwala A F and Jonathan Penm A D
+ Author Affiliations
- Author Affiliations
A School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
B Caboolture Hospital Pharmacy Department, Metro North Health, Queensland Health, Caboolture, Qld, Australia.
C Clinical Pharmacology Department, Royal Brisbane and Women’s Hospital, Queensland Health, Herston, Qld, Australia.
D Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia.
E Redcliffe Hospital Pharmacy Department, Queensland Health, Redcliffe, Qld, Australia.
F Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
* Correspondence to: benita.suckling@health.qld.gov.au
Australian Health Review 46(3) 367-380 https://doi.org/10.1071/AH21353
Submitted: 8 November 2021 Accepted: 17 February 2022 Published: 12 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
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.
Keywords: analgesic, Australia, discharge, emergency, hospital, medication, opioid, pain, persistent use, prescription, surgery.
References
[1] Pattullo C, Suckling B, Taylor S, Thomson J, Collins G, Hall L, Donovan P. Developing and piloting an adaptable oxycodone quality improvement strategy: steps towards opioid stewardship. Aust Health Rev 2021; 45 353–60.| Developing and piloting an adaptable oxycodone quality improvement strategy: steps towards opioid stewardship.Crossref | GoogleScholarGoogle Scholar | 33541521PubMed |
[2] Pouryahya P, Birkett W, McR Meyer AD, Louey S, Belhadfa M, Ferdousi S, Imperial K, Nguyen P, Wang A. Oxycodone prescribing in the emergency department during the opioid crisis. Emerg Med Australas 2020; 32 996–1000.
| Oxycodone prescribing in the emergency department during the opioid crisis.Crossref | GoogleScholarGoogle Scholar | 32537895PubMed |
[3] Roughead EE, Lim R, Ramsay E, Moffat AK, Pratt NL. Persistence with opioids post discharge from hospitalisation for surgery in Australian adults: a retrospective cohort study. BMJ Open 2019; 9 e023990
| Persistence with opioids post discharge from hospitalisation for surgery in Australian adults: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 31488480PubMed |
[4] Veal F, Thompson A, Halliday S, Boyles P, Orlikowski C, Bereznicki L. The persistence of opioid use following surgical admission: an Australian Single-Site Retrospective Cohort Study. J Pain Res 2020; 13 703–8.
| The persistence of opioid use following surgical admission: an Australian Single-Site Retrospective Cohort Study.Crossref | GoogleScholarGoogle Scholar | 32308469PubMed |
[5] Macintyre PE, Huxtable CA, Flint SLP, Dobbin MDH. Costs and consequences: a review of discharge opioid prescribing for ongoing management of acute pain. Anaesth Intensive Care 2014; 42 558–74.
| Costs and consequences: a review of discharge opioid prescribing for ongoing management of acute pain.Crossref | GoogleScholarGoogle Scholar | 25233168PubMed |
[6] Blanch B, Pearson SA, Haber PS. An overview of the patterns of prescription opioid use, costs and related harms in Australia. Br J Clin Pharmacol 2014; 78 1159–66.
| An overview of the patterns of prescription opioid use, costs and related harms in Australia.Crossref | GoogleScholarGoogle Scholar | 24962372PubMed |
[7] Roxburgh A, Bruno R, Larance B, Burns L. Prescription of opioid analgesics and related harms in Australia. Med J Aust 2011; 195 280–4.
| Prescription of opioid analgesics and related harms in Australia.Crossref | GoogleScholarGoogle Scholar | 21895598PubMed |
[8] Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, Bohnert ASB, Kheterpal S, Nallamothu BK. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017; 152 e170504
| New persistent opioid use after minor and major surgical procedures in US adults.Crossref | GoogleScholarGoogle Scholar | 28403427PubMed |
[9] Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo R. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162 276–86.
| The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop.Crossref | GoogleScholarGoogle Scholar | 25581257PubMed |
[10] Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S. Adverse events associated with medium‐ and long‐term use of opioids for chronic non‐cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017; 10 CD012509
| Adverse events associated with medium‐ and long‐term use of opioids for chronic non‐cancer pain: an overview of Cochrane Reviews.Crossref | GoogleScholarGoogle Scholar | 29084357PubMed |
[11] DuPen A, Shen D, Ersek M. Mechanisms of opioid-induced tolerance and hyperalgesia. Pain Manag Nurs 2007; 8 113–21.
| Mechanisms of opioid-induced tolerance and hyperalgesia.Crossref | GoogleScholarGoogle Scholar | 17723928PubMed |
[12] Baldini A, Von Korff M, Lin EH. A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. Prim Care Companion CNS Disord 2012; 14 27252
| A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide.Crossref | GoogleScholarGoogle Scholar |
[13] Lawal OD, Gold J, Murthy A, Ruchi R, Bavry E, Hume AL, Lewkowitz AK, Brothers T, Wen X. Rate and risk factors associated with prolonged opioid use after surgery: a systematic review and meta-analysis. JAMA Netw Open 2020; 3 e207367
| Rate and risk factors associated with prolonged opioid use after surgery: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 32584407PubMed |
[14] Arwi GA, Schug SA. Potential for harm associated with discharge opioids after hospital stay: a systematic review. Drugs 2020; 80 573–85.
| Potential for harm associated with discharge opioids after hospital stay: a systematic review.Crossref | GoogleScholarGoogle Scholar | 32279238PubMed |
[15] Pagé MG, Kudrina I, Zomahoun HTV, Croteau J, Ziegler D, Ngangue P, Martin E, Fortier M, Boisvert E, Beaulieu P, Carbonneau C, Cogan J, Daoust R, Martel M, Néron A, Richebé P, Clarke H. A systematic review of the relative frequency and risk factors for prolonged opioid prescription following surgery and trauma among adults. Ann Surg 2020; 271 845–854.
| A systematic review of the relative frequency and risk factors for prolonged opioid prescription following surgery and trauma among adults.Crossref | GoogleScholarGoogle Scholar | 31188226PubMed |
[16] Corscadden L, Levesque JF, Lewis V, Breton M, Sutherland K, Weenink JW, Haggerty J, Russell G. Barriers to accessing primary health care: comparing Australian experiences internationally. Aust J Prim Health 2017; 23 223–8.
| Barriers to accessing primary health care: comparing Australian experiences internationally.Crossref | GoogleScholarGoogle Scholar | 27927280PubMed |
[17] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 n71
| The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.Crossref | GoogleScholarGoogle Scholar | 33782057PubMed |
[18] Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
[19] Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, Perruolo E, Parati G. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One 2016; 11 e0147601
| Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 26808317PubMed |
[20] Stark N, Kerr S, Stevens J. Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study. Anaesth Intensive Care 2017; 45 700–6.
| Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study.Crossref | GoogleScholarGoogle Scholar | 29137580PubMed |
[21] Kardell LD, Hilmer SN, Crane JA, MacPherson R, Kim TY, Gnjidic D. Investigation of opioid prescribing in the postoperative setting among opioid-naïve surgical patients: a 6-month observational study. J Pharm Pract Res 2019; 49 58–61.
| Investigation of opioid prescribing in the postoperative setting among opioid-naïve surgical patients: a 6-month observational study.Crossref | GoogleScholarGoogle Scholar |
[22] Veal F, Thompson A, Halliday S, Boyles P, Orlikowski C, Huckerby E, Bereznicki L. Does prescribing of immediate release oxycodone by emergency medicine physicians result in persistence of schedule 8 opioids following discharge? Emerg Med Australas 2020; 32 489–93.
| Does prescribing of immediate release oxycodone by emergency medicine physicians result in persistence of schedule 8 opioids following discharge?Crossref | GoogleScholarGoogle Scholar | 31837655PubMed |
[23] Inacio MCS, Hansen C, Pratt NL, Graves SE, Roughead EE. Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study. BMJ Open 2016; 6 e010664
| Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar |
[24] Liu TT, Raju A, Boesel T, Cyna AM, Tan SG. Chronic pain after caesarean delivery: an Australian cohort. Anaesth Intensive Care 2013; 41 496–500.
| Chronic pain after caesarean delivery: an Australian cohort.Crossref | GoogleScholarGoogle Scholar | 23808509PubMed |
[25] Harris IA, Dantanarayana N, Naylor JM. Spine surgery outcomes in a workers’ compensation cohort. ANZ J Surg 2012; 82 625–9.
| Spine surgery outcomes in a workers’ compensation cohort.Crossref | GoogleScholarGoogle Scholar | 22882708PubMed |
[26] Catchpool M, Knight J, Young JT, Clarke P, Barrington MJ, Choong PFM, Dowsey M. Opioid use prior to elective surgery is strongly associated with persistent use following surgery: an analysis of 14 354 Medicare patients. ANZ J Surg 2019; 89 1410–6.
| Opioid use prior to elective surgery is strongly associated with persistent use following surgery: an analysis of 14 354 Medicare patients.Crossref | GoogleScholarGoogle Scholar | 31637832PubMed |
[27] Tran T, Castello J, Taylor SE, Hardidge A, Cannizzaro S, George J, Elliott RA. Opioid use and appropriateness of supply after total knee or hip arthroplasty: an Australian perspective. J Am Acad Orthop Surg 2020; 28 e980–9.
| Opioid use and appropriateness of supply after total knee or hip arthroplasty: an Australian perspective.Crossref | GoogleScholarGoogle Scholar | 32195829PubMed |
[28] Leach MJ, Pratt NL, Roughead EE. Medicine use among older Australians before and after hip fracture. J Pharm Pract Res 2013; 43 265–8.
| Medicine use among older Australians before and after hip fracture.Crossref | GoogleScholarGoogle Scholar |
[29] Veal FC, Bereznicki LR, Thompson AJ, Peterson GM, Orlikowski CE. Pain and functionality following sternotomy: a prospective 12-month observational study. Pain Med 2016; 17 1155–62.
| Pain and functionality following sternotomy: a prospective 12-month observational study.Crossref | GoogleScholarGoogle Scholar | 26814306PubMed |
[30] Hansen CA, Inacio MCS, Pratt NL, Roughead EE, Graves SE. Chronic use of opioids before and after total knee arthroplasty: a retrospective cohort study. J Arthroplasty 2017; 32 811–7.e1.
| Chronic use of opioids before and after total knee arthroplasty: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 27836577PubMed |
[31] Australian Institute of Health and Welfare. Australia’s hospitals at a glance 2018–19. Cat. no. HSE 247. Canberra: AIHW; 2020.
[32] Kline TV, Savage RL, Greenslade JH, Lock CL, Pattullo C, Bell AJ. Affecting emergency department oxycodone discharge prescribing: An educational intervention. Emerg Med Australas 2019; 31 580–6.
| Affecting emergency department oxycodone discharge prescribing: An educational intervention.Crossref | GoogleScholarGoogle Scholar | 30916483PubMed |
[33] Hoppe JA, Kim H, Heard K. Association of emergency department opioid initiation with recurrent opioid use. Ann Emerg Med 2015; 65 493–9.e4.
| Association of emergency department opioid initiation with recurrent opioid use.Crossref | GoogleScholarGoogle Scholar | 25534654PubMed |
[34] Gnjidic D, Du W, Pearson S-A, Hilmer S, Banks E. Ascertainment of self-reported prescription medication use compared with pharmaceutical claims data. Public Health Res Pract 2017; 27 e27341702
| Ascertainment of self-reported prescription medication use compared with pharmaceutical claims data.Crossref | GoogleScholarGoogle Scholar |
