Grant: Travel Awards - Institute Community Support

Over the past 20 years, increases in opioid prescribing rates and average prescription volumes have been documented in both the United States and Canada. As prescription opioid use and overdose has steadily increased in North America, a dramatic rise in hospitalizations resulting from opioid poisonings has also been witnessed. The goal of this study was to describe opioid utilization patterns for patients admitted to a tertiary care hospital in Montreal between 2014 and 2016, and to estimate the association between opioid use and risk of adverse health outcomes in the 90-days post discharge. Opioid use was measured using medication dispensing data from the provincial healthcare databases (RAMQ) while hospital/ED visits were obtained from RAMQ medical services. Time-varying use of opioids was modeled as 1) current use, 2) cumulative duration of use and 2) continuous duration of use, using Cox Proportional Hazards model. Of the 3,308 included patients mean age was 70 (SD 14), 57% were  male and 47% were discharged from surgical units. There were 856 (26%) patients who had a history of opioid use in the 1 year prior to admission, 1528 (46%) who were prescribed an opioid at discharge and 1481 (45%) who filled an opioid in the 90-days post discharge. Among patients prescribed an opioid at discharge, 79% filled their prescription following the hospitalization, where opioid naïve patients as well as those with a history of opioid use were equally likely to fill their prescription. Our multivariable Cox models suggested that current use of opioids was associated with an almost 20% increased risk of emergency department visits and hospitalizations. Increased risk was also found with longer duration of use. Policy and physician-level interventions would need to be put in place to re-assess the optimal duration of opioid treatment following a hospitalization as well as increase the availability to non-pharmacological treatments such as access to physiotherapy services.