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Narcotic pain pill rates high for patients who don't have surgery: Study

Prescription rates for powerful opioid pain pills are high even for hospital patients who haven't had surgery, a new study reveals.

The research, which was published in the Journal of Hospital Medicine on Nov. 13, shows that more than 50 percent of patients who did not undergo a surgical procedure were prescribed an opioid, a type of narcotic painkiller including oxycodone and morphine. Also, 26 percent of non-surgical patients overall were still on the medications when they were discharged from the hospital, the report found.

The pills have high potential for abuse and have been a focus of health officials in recent years as addiction and overdose rates increased in the United States.

Researchers looked at data on 1.4 million hospital admissions from mid-2009 to mid-2010 that took place at 286 U.S. hospitals for the study.

Overall, 43 percent of patients regardless of surgical status were given multiple opioid painkillers during their stay, with the average patient receiving about 68 milligrams of oral morphine equivalents daily. Dr. Shoshana J. Herzig, a hospitalist in Beth Israel Deaconess Medical Center in Boston and instructor in medicine at Harvard Medical School, explained in a press release that this was a "very high dose." She was even more alarmed that 23 percent of patients received a dose equal to or higher than 100 mg on at least one day of their hospital visit.

"Prior studies have found that higher opioid doses are associated with a heightened risk of adverse events," Herzig said. "Patients receiving doses of 100 mg per day or more are at substantially greater risk for serious problems, including severe breathing problems."

The researchers also discovered that there was a 37 percentage point difference in opioid prescription rates in the region of the country with the highest prescribing rates (the Western U.S.) than in the lowest region (Northeast).

Patients who were prescribed the medications at hospitals that had a higher frequency of giving out the pills were at a higher risk for serious complications related to the opioids than those who received the narcotics from a hospital that had lower prescribing rates.

Herzig pointed out that the study shows that there needs to be good communication between the inpatient providers at hospitals and outpatient doctors that treat the patients once they're discharged.

"It's important that primary care physicians know what medications their patients have been exposed to during hospitalizations," Herzig said. "We hope this information will prompt hospitals to take a closer look at their own opioid-prescribing practices. Looking ahead, a better understanding of the predictors of opioid-related adverse events in hospitalized patients might enable institutions to take steps to make these medications safer during hospital use."

Painkiller abuse and addiction is a growing concern in the medical community. A February report revealed that 2010 marked the 11th straight year that drug overdose deaths were on the rise. Sixty percent of those deaths were due to medications, primarily prescription opioid drugs.

Women's painkiller overdose deaths in particular went up 400 percent in the last 10 years, with about five times more women dying due to opioid medications in 2010 than in 1999. Since 2007, women have been at a higher risk of dying from a prescription drug overdose than from passing away in a motor vehicle accident.

In April 2013, the Food and Drug Administration banned generic versions of the original formulation of OxyContin to curb abuse rates. This version of the medication was easily abused because it could crushed, broken or dissolved easier.

The FDA also recently required stricter labeling and more postmarket study requirements for all extended-release and long-acting (ER/LA) opioid pain pills. The updated box warnings now show that these medications may lead to a potentially life-threatening condition for infants known as neonatal opioid withdrawal syndrome (NOWS, or neonatal abstinence syndrome). If a mother uses opioids during pregnancy, the baby has a chance of going through withdrawal after birth and may experience poor feeding habits, rapid breathing, trembling and excessive or high-pitched crying.

The FDA also asked drug companies to complete more studies on the long-term effects of using ER/LA opioid analgesics.

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