Hannah Wunsch1,2,3,4,5, Andrea D Hill1,2, Longdi Fu3, Rob A Fowler1,2,3,4,6, Han Ting Wang7, Tara Gomes3,8,9, Eddy Fan4,6, David N Juurlink2,3,6, Ruxandra Pinto1, Duminda N Wijeysundera3,5,9,10, Damon C Scales1,2,3,4,6. 1. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 2. Sunnybrook Research Institute, Toronto, Ontario, Canada. 3. ICES, Toronto, Ontario, Canada. 4. Interdepartmental Division of Critical Care Medicine. 5. Department of Anesthesia. 6. Department of Medicine, and. 7. Critical Care Division, Department of Medicine, Maisonneuve-Rosemont Hospital affiliated with the University of Montreal, Montreal, Quebec, Canada; and. 8. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. 9. Li Ka Shing Knowledge Institute and. 10. Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
Abstract
Rationale: Patients who receive invasive mechanical ventilation (IMV) are usually exposed to opioids as part of their sedation regimen. The rates of posthospital prescribing of opioids are unknown. Objectives: To determine the frequency of persistent posthospital opioid use among patients who received IMV. Methods: We assessed opioid-naive adults who were admitted to an ICU, received IMV, and survived at least 7 days after hospital discharge in Ontario, Canada over a 26-month period (February, 2013 through March, 2015). The primary outcome was new, persistent opioid use during the year after discharge. We assessed factors associated with persistent use by multivariable logistic regression. Patients receiving IMV were also compared with matched hospitalized patients who did not receive intensive care (non-ICU).Measurements and Main Results: Among 25,085 opioid-naive patients on IMV, 5,007 (20.0%; 95% confidence interval [CI], 19.5-20.5) filled a prescription for opioids in the 7 days after hospital discharge. During the next year, 648 (2.6%; 95% CI, 2.4-2.8) of the IMV cohort met criteria for new, persistent opioid use. The patient characteristic most strongly associated with persistent use in the IMV cohort was being a surgical (vs. medical) patient (adjusted odds ratio, 3.29; 95% CI, 2.72-3.97). The rate of persistent use was slightly higher than for matched non-ICU patients (2.6% vs. 1.5%; adjusted odds ratio, 1.37 [95% CI, 1.19-1.58]).Conclusions: A total of 20% of IMV patients received a prescription for opioids after hospital discharge, and 2.6% met criteria for persistent use, an average of 300 new persistent users per year in a population of 14 million. Receipt of surgery was the factor most strongly associated with persistent use.
Rationale: Patients who receive invasive mechanical ventilation (IMV) are usually exposed to opioids as part of their sedation regimen. The rates of posthospital prescribing of opioids are unknown. Objectives: To determine the frequency of persistent posthospital opioid use among patients who received IMV. Methods: We assessed opioid-naive adults who were admitted to an ICU, received IMV, and survived at least 7 days after hospital discharge in Ontario, Canada over a 26-month period (February, 2013 through March, 2015). The primary outcome was new, persistent opioid use during the year after discharge. We assessed factors associated with persistent use by multivariable logistic regression. Patients receiving IMV were also compared with matched hospitalized patients who did not receive intensive care (non-ICU).Measurements and Main Results: Among 25,085 opioid-naive patients on IMV, 5,007 (20.0%; 95% confidence interval [CI], 19.5-20.5) filled a prescription for opioids in the 7 days after hospital discharge. During the next year, 648 (2.6%; 95% CI, 2.4-2.8) of the IMV cohort met criteria for new, persistent opioid use. The patient characteristic most strongly associated with persistent use in the IMV cohort was being a surgical (vs. medical) patient (adjusted odds ratio, 3.29; 95% CI, 2.72-3.97). The rate of persistent use was slightly higher than for matched non-ICU patients (2.6% vs. 1.5%; adjusted odds ratio, 1.37 [95% CI, 1.19-1.58]).Conclusions: A total of 20% of IMVpatients received a prescription for opioids after hospital discharge, and 2.6% met criteria for persistent use, an average of 300 new persistent users per year in a population of 14 million. Receipt of surgery was the factor most strongly associated with persistent use.
Authors: John W Devlin; Yoanna Skrobik; Céline Gélinas; Dale M Needham; Arjen J C Slooter; Pratik P Pandharipande; Paula L Watson; Gerald L Weinhouse; Mark E Nunnally; Bram Rochwerg; Michele C Balas; Mark van den Boogaard; Karen J Bosma; Nathaniel E Brummel; Gerald Chanques; Linda Denehy; Xavier Drouot; Gilles L Fraser; Jocelyn E Harris; Aaron M Joffe; Michelle E Kho; John P Kress; Julie A Lanphere; Sharon McKinley; Karin J Neufeld; Margaret A Pisani; Jean-Francois Payen; Brenda T Pun; Kathleen A Puntillo; Richard R Riker; Bryce R H Robinson; Yahya Shehabi; Paul M Szumita; Chris Winkelman; John E Centofanti; Carrie Price; Sina Nikayin; Cheryl J Misak; Pamela D Flood; Ken Kiedrowski; Waleed Alhazzani Journal: Crit Care Med Date: 2018-09 Impact factor: 7.598
Authors: Michael L Kent; Robert W Hurley; Gary M Oderda; Debra B Gordon; Eric Sun; Monty Mythen; Timothy E Miller; Andrew D Shaw; Tong J Gan; Julie K M Thacker; Matthew D McEvoy Journal: Anesth Analg Date: 2019-08 Impact factor: 5.108
Authors: Richard A Deyo; Sara E Hallvik; Christi Hildebran; Miguel Marino; Eve Dexter; Jessica M Irvine; Nicole O'Kane; Joshua Van Otterloo; Dagan A Wright; Gillian Leichtling; Lisa M Millet Journal: J Gen Intern Med Date: 2016-08-02 Impact factor: 5.128
Authors: Richard R Riker; Yahya Shehabi; Paula M Bokesch; Daniel Ceraso; Wayne Wisemandle; Firas Koura; Patrick Whitten; Benjamin D Margolis; Daniel W Byrne; E Wesley Ely; Marcelo G Rocha Journal: JAMA Date: 2009-02-02 Impact factor: 56.272
Authors: Damon C Scales; Hadas D Fischer; Ping Li; Arlene S Bierman; Olavo Fernandes; Muhammad Mamdani; Paula Rochon; David R Urbach; Chaim M Bell Journal: J Gen Intern Med Date: 2016-02 Impact factor: 5.128
Authors: Juliana Barr; Gilles L Fraser; Kathleen Puntillo; E Wesley Ely; Céline Gélinas; Joseph F Dasta; Judy E Davidson; John W Devlin; John P Kress; Aaron M Joffe; Douglas B Coursin; Daniel L Herr; Avery Tung; Bryce R H Robinson; Dorrie K Fontaine; Michael A Ramsay; Richard R Riker; Curtis N Sessler; Brenda Pun; Yoanna Skrobik; Roman Jaeschke Journal: Crit Care Med Date: 2013-01 Impact factor: 7.598
Authors: Hannah Wunsch; Andrea D Hill; Jennifer Bethell; Longdi Fu; Brian T Bateman; Karim S Ladha; Duminda N Wijeysundera; Mark D Neuman Journal: Ann Surg Date: 2021-11-23 Impact factor: 13.787
Authors: Luis E Tollinche; Kenneth P Seier; Gloria Yang; Kay See Tan; Yekaterina D Tayban; Stephen M Pastores; Cindy B Yeoh; Kunal Karamchandani Journal: J Crit Care Date: 2021-11-29 Impact factor: 4.298
Authors: Robinder G Khemani; Jessica T Lee; David Wu; Edward J Schenck; Margaret M Hayes; Patricia A Kritek; Gökhan M Mutlu; Hayley B Gershengorn; Rémi Coudroy Journal: Am J Respir Crit Care Med Date: 2021-05-01 Impact factor: 21.405
Authors: Pamela MacTavish; Tara Quasim; Colin Purdie; Morna Ball; Lesley Barker; Sarah Connelly; Helen Devine; Philip Henderson; Lucy A Hogg; Rakesh Kishore; Phil Lucie; Jennifer Murphy; Peter O'Brien; Martin Shaw; Laura Strachan; Alan Timmins; Theodore J Iwashyna; Joanne McPeake Journal: Ann Am Thorac Soc Date: 2020-10
Authors: Shannon M Fernando; Danial Qureshi; Manish M Sood; Michael Pugliese; Robert Talarico; Daniel T Myran; Margaret S Herridge; Dale M Needham; Bram Rochwerg; Deborah J Cook; Hannah Wunsch; Robert A Fowler; Damon C Scales; O Joseph Bienvenu; Kathryn M Rowan; Magdalena Kisilewicz; Laura H Thompson; Peter Tanuseputro; Kwadwo Kyeremanteng Journal: BMJ Date: 2021-05-05
Authors: Matthew S Duprey; Harmony Allison; Erik Garpestad; Andrew M Riselli; Anthony Faugno; Eric Anketell; John W Devlin Journal: Crit Care Res Pract Date: 2022-03-20
Authors: Chelsea Wampole; Ariel McKenna; Richard R Riker; Teresa L May; David B Seder; Dawn Abram; Gilles L Fraser; David J Gagnon Journal: Crit Care Explor Date: 2022-07-26
Authors: Katalina Chan; Lisa D Burry; Christopher Tse; Hannah Wunsch; Charmaine De Castro; David R Williamson Journal: Ann Pharmacother Date: 2022-01-26 Impact factor: 3.463