Researchers tally the physical and financial costs of opioid painkillers' side effects

May 28, 2018 by Karen Kaplan, Los Angeles Times
Credit: CC0 Public Domain

The opioid crisis has shown us that prescription painkillers and their illicit counterparts can wreak havoc in American communities. Now researchers have quantified the damage they can do inside hospitals when administered to patients following surgeries and other invasive medical procedures.

More than 10 percent of hospitalized patients who took one or more opioid painkillers experienced a side effect tied to the drug, according to a study published Wednesday in the journal JAMA Surgery. Fully 93 percent of these patients suffered at least one episode that was deemed moderate or severe.

These findings are based on medical records of patients who were treated at 21 acute care hospitals that are part of the Baylor Scott & White Health in Texas. All of the patients had some kind of surgery (such as cardiac or orthopedic) or an endoscopic procedure between 2013 and 2016, and all of them had their pain treated with opioids.

What the study authors were looking for were instances of -related adverse drug events, or ORADEs for short. And they found them.

Among the 135,379 patients included in the study, 14,386—or 10.6 percent—had at least one ORADE.

The most common type of adverse events involved a respiratory problem, including the need to be put on a ventilator. Other problems included a painful intestinal obstruction called an ileus; an abnormally slow heart rate (bradycardia); nausea and vomiting; confusion and delirium; and skin problems like severe itching or a rash.

Most of these patients had only one such side effect. But 27 percent of them experienced two or more ORADES, according to the study. A little more than half (56 percent) of these problems were considered "moderate," and more than one-third (37 percent) were classified as "severe."

These episodes were more than a nuisance. Compared with patients who took opioids without incident, those who experienced an ORADE were nearly 29 times more likely to die before leaving the , the researchers reported. They were also about 3 times more likely to have a longer hospital stay and to be discharged to another "care facility" instead of being sent home.

The researchers calculated that ORADEs were associated with an extra 1.6 days of hospitalization and $8,225 in additional hospital bills.

These calculations accounted for the fact that patients who had ORADEs were more likely to be older, to be men, to be non-Latino whites, and to have health coverage through Medicare. They also had more health problems, which the researchers said was understandable considering their age.

The with adverse effects were also different from their counterparts in the way they used opioids. They took the painkillers for about one day longer (a median of 3 days, compared with a median of 2) and received higher doses too (a median of 47 morphine milligrams equivalents, compared with a median of 30 mg).

Importantly, the study doesn't claim that the side effects of opioids caused any of these observed differences—only that they are linked. It could be that some third factor is responsible for both the side effects and the need to extend a .

The researchers also warned that these results might not apply patient populations from other parts of the country who are treated by other health systems.

Explore further: Inpatient opioid use and insufficient weaning pre-discharge may increase outpatient opioid prescript

Related Stories

Inpatient opioid use and insufficient weaning pre-discharge may increase outpatient opioid prescript

May 21, 2018
According to the University of Pittsburgh School of Medicine scientists who conducted the study, theirs is the first large-scale evaluation of the impact of in-hospital opioid prescribing on post-discharge opioid use.

Less is more when it comes to prescription opioids for hospital patients, study finds

May 14, 2018
In a pilot study published in JAMA Internal Medicine, Yale researchers significantly reduced doses of opioid painkillers given to hospital patients. By delivering the opioids with a shot under the skin or with a pill instead ...

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Opioid use linked to increased risk of falls, death in older adults

April 23, 2018
Opioid use linked to increased risk of falls, death in older adultsRecent opioid use is associated with an increased risk of falls in older adults and an increased risk of death, found new research in CMAJ (Canadian Medical ...

Evidence-based approach to treating post-delivery pain in new moms during opioid crisis

November 14, 2017
Women who undergo vaginal delivery often do not require opioids to manage pain after hospital discharge, concludes a study published in Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists ...

Almost one in three patients used no opioids prescribed after surgery, survey finds

April 19, 2018
Nearly a third of patients responding to a Mayo Clinic survey said they used none of the opioids they were prescribed after surgery. The research findings, presented Thursday, April 19 at the American Surgical Association ...

Recommended for you

Medicating distress: Risky sedative prescriptions for older adults vary widely

October 18, 2018
Despite years of warnings that older adults shouldn't take sedative drugs that put them at risk of injury and death, a new study reveals how many primary care doctors are still prescribing them, how often, and exactly where.

Medical management of opioid-induced constipation differs from other forms of condition

October 17, 2018
Traditional laxatives are recommended as first-line agents to treat patients with a confirmed diagnosis of opioid-induced constipation (OIC), according to a new guideline from the American Gastroenterological Association ...

Research assesses geographic distribution of new antibiotics following market introduction

October 16, 2018
There is a growing need for new antibiotics to help combat the looming threat of antimicrobial resistance. According to a new study conducted by researchers at the Center for Disease Dynamics, Economics & Policy (CDDEP) with ...

Health insurer policies may discourage use of non-opioid alternatives for lower back pain

October 5, 2018
Public and private health insurance policies in the U.S. are missing important opportunities to encourage the use of physical therapy, psychological counseling and other non-drug alternatives to opioid medication for treating ...

Opioid overdoses, depression linked

October 3, 2018
The link between mental health disorders and substance abuse is well-documented. Nearly one in 12 adults in the U.S is depressed, and opioid-related deaths are skyrocketing. As these numbers continue to climb, some mental ...

Do price spikes on some generic drugs indicate problems in the market?

October 1, 2018
A new USC study reports that sudden price spikes for some generic drugs—such as the recently reported increases of a decades-old generic heart medication and an antibiotic—are becoming more common.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.