Younger age, other factors associated with new OUD diagnosis after hospitalization

Age and history of nonopioid-related drug disorder are among the factors associated with new diagnosis of opioid use disorder (OUD) after hospitalization, a recent study found.

Researchers conducted a retrospective cohort study of data from electronic health records, pharmacy claims, and medical claims for opioid-naive patients who received at least one prescription for an opioid during an inpatient stay between 2014 and 2017. Patients were categorized into a surgical or nonsurgical cohort based on Current Procedural Terminology codes. The study's primary objective was to determine baseline factors associated with a new OUD diagnosis within 12 months of discharge. Baseline covariates included demographic information, clinical characteristics, medication use, characteristics of the index hospital encounter, and discharge location. The results were published May 16 by the Journal of Hospital Medicine.

A total of 23,033 opioid-naive patients were included in the study, and 2.1% had a new diagnosis of OUD within a year of receiving an opioid during hospitalization. Odds of a new OUD diagnosis were higher in patients ages 25 to 34 years versus those 65 years of age and older (odds ratio [OR], 6.98 [95% CI, 4.02 to 12.1] in the nonsurgical cohort and 4.69 [95% CI, 2.63 to 8.37] in the surgical cohort).

Patients from a high opioid geo-rank region, defined as a region with more opioid consumption measured by days' supply of opioid use per 1,000 persons by ZIP code, were also more likely to have an OUD diagnosis (OR, 2.08 [95% CI, 1.31 to 3.31] and 1.80 [95% CI, 1.03 to 3.15] for the nonsurgical and surgical cohorts, respectively). History of nonopioid-related drug disorder, tobacco use disorder, mental health conditions, gabapentin use 12 months before the index date, and White race were also associated with higher odds of new OUD diagnosis.

The researchers noted that their study could not prove causality, that some patients who were not opioid-naive may have been included, and that they did not have access to state prescription drug monitoring data, among other limitations. They said that knowledge of individual risk for OUD could help clinicians develop pain management strategies for high-risk patients.

“This could involve earlier pain management consultation, more aggressive nonopioid anticipatory pain treatments, and provision of patient counseling and education of their risk of OUD as part of a shared decision model for pain management,” the authors wrote. “Furthermore, these patients might be referred for closer outpatient follow-up, with concern for subsequent OUD because of inpatient opioid exposure. Ongoing outpatient pain after discharge should not go unaddressed, which could lead to OUD including illicit drug use.”