Opioid creep in burn center discharge regimens: Doubled amounts and complexity of narcotic prescriptions over seven years. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Tully, Andy; Anderson, Lillian; Adams, William; Mosier, Michael J.
• Is Part Of: Burns. Volume 45:Issue 2(2019)
• Page Start: 328
• Page End: 334
• Publication Date: 2019-03
• Subjects: Burn pain -- Burns -- Prescription opioid -- Acute pain management opoid; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2018.08.004
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Adult burn patients in 2015 were prescribed nearly two times more narcotics (morphine equivalents) on discharge than in 2008. Adult burn patients in 2015 were nearly twice as likely to receive a more complex opioid regimen than in 2008. Patients with Medicare were prescribed less total narcotic than patients with private insurance. Patients with Medicaid were prescribed a more complex regimen of narcotics than patients with private insurance. Abstract: Prescription opioid misuse is an epidemic international health crisis. Although burn providers are increasingly mindful of balancing pain relief with risk of opioid dependence, several burn centers have noticed their patients are still receiving an increased amount of opioids, termed "opioid creep." We examined discharge narcotic prescriptions at a single burn center in the Midwest United States and found that patients discharged in 2015 received nearly twice the amount of narcotics (mean = 600 morphine equivalents [ME]) than those discharged in 2008 (mean = 350 ME), with a significantly increased likelihood of a more complex narcotic discharge regimen. The increase in ME remained significant even after controlling for age, burn size, intensive care unit stay, discharge day, substance abuse, comorbidity status, insurance, language, race, and ethnicity. The data do not clearly explain such a significant increase. Although such increase in opioid prescription is undesirable, so too is regression to historical under-treatment of burn pain. Protocoled pain-management order sets on admission and discharge, as well as incorporation of alternatives adjuncts to lessen pain, may allow for better pain control with less opioid misuse.