Association of opioid exposure during intensive care unit stays with post-discharge opioid use: A retrospective study and literature review

Yoonsun Mo, MS, PharmD, BCPS, BCCCP; John Zeibeq, MD; Nabil Mesiha, MD; Abou Bakar, PharmD; Maram Sarsour, PharmD; Michelle Liu, PharmD; James Gasperino, MD, PhD, MPH, DABT

doi:10.5055/jom.2021.0685

Authors

Yoonsun Mo, MS, PharmD, BCPS, BCCCP https://orcid.org/0000-0002-8455-1648
John Zeibeq, MD
Nabil Mesiha, MD
Abou Bakar, PharmD
Maram Sarsour, PharmD
Michelle Liu, PharmD
James Gasperino, MD, PhD, MPH, DABT

DOI:

https://doi.org/10.5055/jom.2021.0685

Keywords:

opioid, analgosedation, intensive care unit, pain, analgesic

Abstract

Objective: To evaluate whether pain management strategies within intensive care unit (ICU) settings contribute to chronic opioid use upon hospital discharge in opioid-naive patients requiring invasive mechanical ventilation.

Design: A retrospective, observational study.

Setting: An 18-bed mixed ICU at a community teaching hospital located in Brooklyn, New York.

Participants: This study included mechanically ventilated patients requiring continuous opioid infusion from April 25, 2017 to May 16, 2019. Patients were excluded if they received chronic opioid therapy at home or expired during this hospital admission. Eligible patients were identified using an electronic health record data query.

Main outcome measure(s): The proportion of ICU patients who continued to require opioids upon ICU and hospital discharge.

Results: A total of 196 ICU patients were included in this study. Of these, 22 patients were transferred to a regular floor while receiving a fentanyl transdermal patch. However, the fentanyl patch treatment was continued only for three patients (2 percent) at hospital discharge.

Conclusions: This retrospective study suggested that high-dose use of opioids in mechanically ventilated, opioid-naive ICU patients was not associated with continued opioid use upon hospital discharge.

Author Biographies

Yoonsun Mo, MS, PharmD, BCPS, BCCCP

Associate Professor of Pharmacy Practice, Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Clinical Pharmacy Coordinator, Critical Care, The Brooklyn Hospital Center, Brooklyn, New York

John Zeibeq, MD

Attending Physician & Director of Critical Care Education, Division of Critical Care Medicine, Department of Medicine, Center for Critical Care Services, The Brooklyn Hospital Center, Brooklyn, New York

Nabil Mesiha, MD

Attending Physician, Division of Critical Care Medicine, Department of Medicine, Center for Critical Care Services, The Brooklyn Hospital Center, Brooklyn, New York

Abou Bakar, PharmD

Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York

Maram Sarsour, PharmD

Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York

Michelle Liu, PharmD

Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York

James Gasperino, MD, PhD, MPH, DABT

Chair, Department of Medicine; Vice President for Critical Care, Perioperative, and Hospitalist Medicine; Associate Chief Medical Officer, Division of Critical Care Medicine, Department of Medicine, Center for Critical Care Services, The Brooklyn Hospital Center, Brooklyn, New York

References

Scholl L, Seth P, Zariisa M, et al.: Drug and opioid-involved overdose deaths-United States 2013-2017. MMWR Morb Mortal Wkly Rep. 2019; 67(5152): 1419-1427.

Understanding the Epidemic | Drug Overdose | CDC Injury Center. 2018. Available at https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed June 16, 2019.

Seth P: Overdose deaths involving opioids, cocaine, and psychostimulants—United States. MMWR Morb Mortal Wkly Rep. 2018; 67: 349-2016.

Devlin JW, Skrobik Y, Gélinas C, et al.: Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018; 46(9): E825-E873.

Erstad BL: Implications of the opioid epidemic for critical care practice. J Am Coll Clin Pharm. 2019; 2(2): 161-166.

Yaffe PB, Green RS, Butler MB, et al.: Is admission to the intensive care unit associated with chronic opioid use? A 4-year follow-up of intensive care unit survivors. J Intensive Care Med. 2017; 32(7): 429-435.

Adil MQ, Cruz AD, Thornton JD, et al.: Incidence of chronic opioid use in previously opioid-naïve patients receiving opioids for analgesia in the intensive care unit. Fed Pract. 2020; 37(4): 170-176.

Dunn LK, Taylor DG, Smith SJ, et al.: Persistent post-discharge opioid prescribing after traumatic brain injury requiring intensive care unit admission: A cross-sectional study with longitudinal outcome. PLoS One. 2019; 14: E0225787. DOI: 10.1371/journal.pone.0225787.

Wunsch H, Hill AD, Fu L, et al.: New opioid use after invasive mechanical ventilation and hospital discharge. Am J Respir Crit Care Med. 2020; 202(4): 568-575.

Wang HT, Hill AD, Gomes T, et al.: Opioid use after ICU admission among elderly chronic opioid users in Ontario: A population-based cohort study. Crit Care Med. 2018; 46(12): 1934-1942.

Oelreich E, Eriksson M, Sjolund K, et al.: Opioid use after intensive care: A nationwide cohort study. Crit Care Med. 2021; 49(3): 462-471.