(969) Opioid Utilization and Continuation in Opioid-Naive Nonsurgical Critically Ill Patients

Introduction: The relationship between opioid use in Intensive Care Units (ICUs) and continued use after hospital discharge is not well-established in opioid-naïve, non-surgical patients. The objective of the study is to evaluate the association between opioid utilization in community-based ICUs and the incidence of opioid prescriptions at hospital discharge for non-surgical, opioid-naïve patients.

Methods: This nested case-control included adult patients admitted to medical ICUs at two community hospitals from 01/2020 to 07/2022. Eligible patients were adults without opioid prescriptions 45 days before hospital admission, had ICU stay ≥ 48 hours, and received enhanced oxygen therapy. Exclusions were opioid allergies, cancer, in-hospital death, palliative care, major surgery, and substance use disorders. Opioid utilization was measured using cumulative oral morphine milligram equivalent (MME) and average daily MME during ICU stay. Multivariable regression models examined the association between opioid utilization during ICU stay and continuation of opioid prescription at discharge. Additional risk factors for continued opioid use were also explored.

Results: Among 260 analyzed patients, 33 (12.7%) patients received opioid prescriptions at discharge. These cases received significantly higher total MME in ICU (cases: 3,362.4 [standard-error-of-the-mean (SEM) 1,102.5] versus controls: 1,024.9 [SEM 240.0], p=0.002) and higher daily MME in ICU (cases: 129.8 [SEM 36.9] versus controls: 61.2 [SEM 10.7], p=0.03). Patients who received > 90 MME cumulatively during ICU stay had 6.63 times the odds of opioid continuation at discharge compared to patients who did not (p < 0.001). Each additional 10 daily MME in the ICU increased discharge continuation odds by 3% (p=0.011). Other factors associated with opioid continuation at hospital discharge included shorter pre-ICU stays, liver disease, age between 45-65, higher daily MME between ICU and hospital discharge, and being transferred to short-term hospitals.

Conclusions: Increased opioid utilization during ICU stay was associated with increased odds of continuation of opioid prescription at hospital discharge in opioid-naïve, non-surgical patients.