(1026) U.S. Opioid Prescribing Practices After ICU Hospitalizations Requiring Mechanical Ventilation

Introduction: Opioids, frequently initiated during ICU admissions requiring invasive mechanical ventilation (IMV), are often continued after hospital discharge despite important concerns re: this use. Current U.S. post-hospital use of opioids in ICU survivors who required IMV and factors associated with this use remain unclear.

Methods: Using the U.S. IQVIA PharMetrics Plus claims database we identified adults in 2021 admitted to an ICU requiring IMV and discharged directly to home with insurance coverage ≥30 days. We excluded patients with OUD or a recent ICU admission. We collected data on age, sex, comorbidity (CCI), frailty (HFRS), admission diagnoses, and full opioid agonist prescriptions in the two months before-and-after the ICU hospitalization and conducted a 5-variable logistic regression analysis to identify factors associated with post-hospitalization opioid prescribing in patients opioid-naive prior to ICU hospitalization.

Results: Among 2707 patients included, 2341(86.5%) were opioid-naïve [age 67(57-76), male(56.3%), CCI 5(3,8), HDRI 11(6,18) and surgical(14.4%] and 364(13.5%) were opioid-experienced. A total of 197(8.4%) opioid-naive patients were prescribed ≥1 opioid in the 2-months after ICU hospitalization. First-prescribed opioids included oxycodone 115(58.3%), hydrocodone 70(35.5%), codeine 16(8.1%) and transdermal fentanyl 1(0.5%)]; acetaminophen-containing opioid formulations made up 56.7% of these prescriptions. In the opioid-naïve group, a surgical (vs. medical) diagnosis (aOR 6.41 95%CI 4.67,8.79) was associated with greater post-hospital opioid prescribing and age (aOR 0.98 95%CI 0.97,0.99], male gender (aOR 0.74 95%CI 0.87,1.40), and baseline comorbidity (aOR 0.99 95%CI 0.94,1.04) were associated with less. Opioids were not prescribed post-hospitalization in 168/364(48.7%) of the opioid-experienced patients. The total 2-month oral MME prescribed was greater in the 177 opioid-experienced patients prescribed opioids post-hospitalization than the 364 opioid-experienced patients before hospitalization [1350(341,2535) vs 815(150,2062),p=0.01]

Conclusions: Post-hospital opioid prescribing after an ICU admission requiring IMV appears to be lower in the U.S. than that reported in other countries for both opioid-naive and opioid-experienced patients.