Objective: To describe the patterns of opioid prescribing and the factors associated with reductions
in the potency of patients' analgesic medications at the time of hospital discharge.
Design: Prospective cohort
Setting: Two hundred forty-four patients (171 surgical and 73 nonsurgical) hospitalized in
an urban academic medical center who have experienced moderate or severe pain and who
are taking opioid analgesics prior to discharge.
Outcome: Step-down (or reduction) in the potency of patients' analgesic medication at the
time of discharge. A step-down is defined as the analgesic medication that a patient is prescribed
for outpatient analgesia at the time of discharge being less potent then the last pain
medication administered to that patient just prior to hospital discharge.
Results: Thirty-three percent of all patients had reductions in the potency of their opioid
pain medication at the time of discharge (36% for surgical and 26% for nonsurgical patients).
For nonsurgical patients, we found a trend toward Hispanic ethnicity being an independent
risk factor for having a step-down in analgesic potency at discharge (odds ratio [OR]: 3.7, 95%
confidence interval [CI]: 0.9–14.9).
Conclusion: Physicians frequently reduce the potency of hospitalized patients' pain medications
at discharge and Hispanic patients may be at increased risk of this occurring. Further
research is needed to determine if the reductions in analgesic potency we observed are associated
with poor posthospital pain outcomes.
