The effect of the COVID-19 pandemic on opioid prescribing for patients with pleuritic pain

Andrew Ormsby, MD; Caitlin Dietsche, MD

doi:10.5055/jom.2022.0748

Authors

Andrew Ormsby, MD https://orcid.org/0000-0002-6066-9959
Caitlin Dietsche, MD

DOI:

https://doi.org/10.5055/jom.2022.0748

Keywords:

opioid prescribing, internal medicine, inpatient, pain management, COVID-19

Abstract

Objective: We sought to understand opioid prescribing for COVID-19 positive and negative patients with pleuritic pain during the first wave of the pandemic. We hypothesized that patients without COVID-19 would be prescribed opioids more frequently intrapandemic compared to prepandemic and postulated that COVID-19 patients would be prescribed opioids more frequently and at greater quantity than their peers.

Design: A retrospective observational analysis of electronic health record data.

Setting: A quaternary academic hospital from February through April 2020.

Participants: A total of 1,400 of 3,169 adult inpatient hospitalizations involving pleuritic pain were included.

Main measures: Frequency and average daily dose of opioid prescriptions were analyzed using logistic and linear regression. Opioid prescribing habits were compared pre- and intrapandemic. Hypotheses and primary outcome measures were formulated prior to data collection.

Key results: During the pandemic, COVID-19 patients were 15.77 absolute percentage points less likely to be prescribed opioids compared to patients without COVID-19 (95 percent confidence interval (CI): –8.98 to –22.56 percent). Patients without COVID-19 were equally likely to be prescribed opioids pre- and intrapandemic (95 percent CI: –9.37 to 2.42 percent). Odds ratio of opioid prescription for COVID-19 patients was 0.44 (95 percent CI: 0.08-0.80). Within those given opioids, COVID-19 patients were prescribed 3.0 percent greater morphine milligram equivalents (MMEs) (95 percent CI: 1.07-5.85 percent).

Conclusion: During the first wave of the pandemic, COVID-19 patients with pleuritic pain were prescribed opioids less frequently than patients without COVID-19, while patients without COVID-19 were equally likely to be prescribed opioid pre- and intrapandemic. On the other hand, COVID-19 patients treated with opioids were given greater daily MMEs due to the greater utilization of opioid infusions.

Author Biographies

Andrew Ormsby, MD

Medical Student, University of Colorado School of Medicine, Denver, Colorado

Caitlin Dietsche, MD

Assistant Professor of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado

References

Hedegaard H, Miniño AM, Warner M: Drug overdose deaths in the United States, 1999–2018. NCHS Data Brief, no 356. Hyattsville, MD: National Center for Health Statistics. 2020.

Centers for Disease Control: Provisional drug overdose death counts. Vital statistics rapid release. Available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Accessed January 28, 2021.

O’Donnell J, Gladden RM, Mattson CL, et al.: Vital signs: Characteristics of drug overdose deaths involving opioids and stimulants—24 states and the District of Columbia, January–June 2019. MMWR Morb Mortal Wkly Rep. 2020; 69: 1189-1197. DOI: 10.15585/mmwr.mm6935a1external icon.

Ho JY, Hendi AS: Recent trends in life expectancy across high income countries: Retrospective observational study. BMJ. 2018; k2562. DOI: 10.1136/bmj.k2562.

Donohue JM, Kennedy JN, Seymour CW, et al.: Patterns of opioid administration among opioid-naive inpatients and associations with postdischarge opioid use. Ann Intern Med. 2019; 171(2): 81. DOI: 10.7326/m18-2864.

Alexander GC, Stoller KB, Haffajee RL, et al.: An epidemic in the midst of a pandemic: Opioid use disorder and COVID-19. Ann Internal Med. 2020; 173(1): 57-58. DOI: 10.7326/m20-1141.

Duncan RW, Smith KL, Maguire M, et al.: Alternatives to opioids for pain management in the emergency department decreases opioid usage and maintains patient satisfaction. Am J Emerg Med. 2019; 37(1): 38-44. DOI: 10.1016/j.ajem.2018.04.043.

Haley DF, Saitz R: The opioid epidemic during the COVID-19 pandemic. JAMA. 2020; 324(16): 1615-1617. DOI: 10.1001/jama.2020.18543.

Cohen SP, Baber ZB, Buvanendran A, et al.: Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises. Pain Med. 2020; 21(7): 1331-1346. DOI: 10.1093/pm/pnaa127.

Grasselli G, Zangrillo A, Zanella A, et al.: Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA. 2020; 323(16): 1574-1581. DOI: 10.1001/jama.2020.5394.

Yang X, Yu Y, Xu J, et al.: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet. 2020; 8(5): 475-481. DOI: 10.1016/S2213-2600(20)30079-5.

Rees EM, Nightingale ES, Jafari Y, et al.: COVID-19 length of hospital stay: A systematic review and data synthesis. BMC Med. 2020; 18(18). DOI: 10.1186/s12916-020-01726-3.

Ochalek TA, Cumpston KL, Wills BK, et al.: Nonfatal opioid overdoses at an urban emergency department during the COVID-19 pandemic. JAMA. 2020; 324(16): 1673-1674. DOI: 10.1001/jama.2020.17477.

Wainwright JJ, Mikre M, Whitley P, et al.: Analysis of drug test results before and after the US declaration of a national emergency concerning the COVID-19 outbreak. JAMA. 2020; 324(16): 1674-1677. DOI: 10.1001/jama.2020.17694.

Slavova S, Rock P, Bush HM, et al.: Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Depend. 2020; 214: 108176. DOI: 10.1016/j.drugalcdep.2020.108176.

Opioid Task Force: Physicians’ progress toward ending the nation’s drug overdose and death epidemic. American Medical Association, 2020. Available at www.ama-assn.org/system/files/2020-07/opioid-task-force-progress-report.pdf. Accessed January 28, 2021.

Aitken M: Prescription Opioid Trends in the United States. Measuring and Understanding Progress in the Opioid Crisis. IQVIA Institute, 2020.

Schieber LZ, Guy GP Jr, Seth P, et al.: Variation in adult outpatient opioid prescription dispensing by age and sex—United States, 2008–2018. MMWR Morb Mortal Wkly Rep. 2020; 69: 298-302. DOI: 10.15585/mmwr.mm6911a5.

Center for Preparedness and Response: Increase in fatal drug overdoses across the United States driven by synthetic opioids before and during the COVID-19 pandemic. Center or Disease Control and Prevention. 2020. Available at https://emergency.cdc.gov/han/2020/han00438.asp. Accessed January 28, 2021.

Silva MJ, Kelly Z: The escalation of the opioid epidemic due to COVID-19 and resulting lessons about treatment alternatives. Am J Manag Care. 2020; 26(7). DOI: 10.37765/ajmc.2020.43386.