To describe opioid use before and after intensive care unit (ICU) admission and to identify factors associated with chronic opioid use upto 4 years after ICU discharge.
Methods:
Retrospective review of adult patients admitted to the ICU at a tertiary care center between January 1, 2005, to December 31, 2008. We defined “nonuser,” “intermittent,” and “chronic” opioid status by abstinence, use in <70%, and >70% of days for a given time period, respectively. We assessed opioid use at 3 months prior to ICU admission, at discharge, and annually for upto 4 years following ICU discharge.
Results:
A total of 2595 ICU patients were included for surgical (48.6%), medical (38.4%), and undetermined (13%) indications. The study population included both elective (26.9%) and emergent (73.1%) admissions. Three months prior to ICU admission, 76.9% were nonusers, 16.9% used opioids intermittently, and 6.2% used opioids chronically. We found an increase in nonuser patients from 87.8% in the early post-ICU period to 95.6% at 48-month follow-up. Consequently, intermittent and chronic opioid use dropped to 8.6% and 3.6% at discharge and 2.6% and 1.8% at 48-month follow-up, respectively. Prolonged hospital length of stay was associated with chronic opioid use.
Conclusion:
Admission to ICU and duration of ICU stay were not associated with chronic opioid use.
DegenhardtLCharlsonFMathersBHallWDFlaxmanADJohnsN. The global epidemiology and burden of opioid dependence: results from the global burden of disease 2010 study. Addiction. 2014;109(8):1320–1333.
2.
KuehnBM. Opioid prescriptions soar: increase in legitimate use as well as abuse. JAMA. 2007;297(3):249–251.
BirnbaumHGWhiteAGSchillerMWaldmanTClevelandJMRolandCL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011;12(4):657–667.
7.
DevlinJWRobertsRJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Crit Care Clin. 2009;25(3):431–449.
8.
BarrJFraserGLPuntilloK; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(4):263–306.
9.
HerridgeMSTanseyCMMatteA; Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–1304.
10.
TimmersTKVerhofstadMHMoonsKGvan BeeckEFLeenenLP. Long-term quality of life after surgical intensive care admission. Arch Surg. 2011;146(4):412–418.
11.
RaebelMANewcomerSRBaylissEA. Chronic opioid use emerging after bariatric surgery. Pharmac oepidemiol Drug Saf. 2014;23(12):1247–1257.
12.
ChouRTurnerJADevineEB. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015;162(4):276–286.
13.
MoulinDEClarkAJSpeechleyMMorley-ForsterPK. Chronic pain in canada--prevalence, treatment, impact and the role of opioid analgesia. Pain Res Manag. 2002;7(4):179–184.
14.
HardenRN. Chronic pain and opiates: A call for moderation. Arch Phys Med Rehabil. 2008;89(3 suppl 1):s72–s76.
15.
AngusDCBarnatoAELinde-ZwirbleWTWeissfeldLAWatsonRSRickertTRubenfeldGD; Robert Wood Johnson Foundation ICU End-Of-Life Peer Group. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004;32(3):638–643.
16.
MularskiRA. Pain management in the intensive care unit. Crit Care Clin. 2004;20(3):381–401.
17.
FreireAXAfessaBCawleyPPhelpsSBridgesL. Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome. Crit Care Med. 2002;30(11):2468–2472.
Caudill-SlosbergMASchwartzLMWoloshinS. Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000. Pain. 2004;109(3):514–519.
20.
Centers for Disease Control and Prevention. Adult use of prescription opioid pain medications – Utah, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(6):153–157.
21.
ManchikantiLHelmSFellowsB. Opioid epidemic in the United States. Pain Physician. 2012;15(3 suppl):es9–es38.
22.
HerridgeMS. Mobile, awake and critically ill. CMAJ. 2008;178(6):725–726.
23.
DowdyDWEidMPDennisonCR. Quality of life after acute respiratory distress syndrome: a meta-analysis. Intensive Care Med. 2006;32(8):1115–1124.
24.
SimanskiCJAlthausAHoederathS. Incidence of chronic postsurgical pain (CPSP) after general surgery. Pain Med. 2014;15(7):1222–1229.
25.
MacraeWA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77–86.
26.
JeneweinJMoergeliHWittmannLBüchiSKraemerBSchnyderU. Development of chronic pain following severe accidental injury. Results of a 3-year follow-up study. J Psychosom Res. 2009;66(2):119–126.
27.
TrevinoCMdeRoon-CassiniTBraselK. Does opiate use in traumatically injured individuals worsen pain and psychological outcomes?J Pain. 2013;14(4):424–430.
LiebschutzJMSaitzRWeissRD. Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain. J Pain. 2010;11(11):1047–1055.
30.
ManubayJMMuchowCSullivanMA. Prescription drug abuse: epidemiology, regulatory issues, chronic pain management with narcotic analgesics. Prim Care. 2011;38(1):71–90.
31.
CannonRBozemanMMillerKR. The prevalence and impact of prescription controlled substance use among injured patients at a Level I trauma center. J Trauma Acute Care Surg. 2014;76(1):172–175.
RosenbergALHoferTPHaywardRAStrachanCWattsCM. Who bounces back? Physiologic and other predictors of intensive care unit readmission. Crit Care Med. 2001;29(3):511–518.
34.
MullinsGBrousseauPMilneADMacDougallP. Characterization of the COAP dataset: A novel tool to analyze the relationship between surgical admissions and the prescribing of controlled opioids in Nova Scotia. Paper presented at: Canadian Undergraduate Conference on Healthcare; November 17, 2012; Kingston, Canada.
