Patterns of Opioid Use in the 12 Months Following Geriatric Fragility Fractures: A Population-Based Cohort Study.
Michael T Torchia, Jeffrey Munson, Tor D Tosteson and 6 others
PMID 30824217WHAT IT FOUND
One year after hip, shoulder or wrist fragility fractures, 3.8% to 6.4% of previously opioid-naive Medicare patients were still filling opioids.
Surgery for wrist or shoulder fractures was associated with more fills for six months, and state variation was 2.4-fold.
Key findings
01At 12 months, 6.4% of hip fracture patients, 5.7% of proximal humerus fracture patients and 3.8% of distal radius fracture patients continued filling opioid prescriptions.
02For proximal humerus and distal radius fractures, surgically treated patients had higher opioid use every month up to month 6 than non-surgically treated patients.
03At three months, opioid use varied 2.4-fold across states, from 18.2% in Oklahoma to 7.5% in Connecticut.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study had no comparison group of opioid-naive Medicare patients without fractures, so it cannot show whether fracture patients used opioids more than other people of similar age and health. Follow-up was only one year, so opioid use beyond one year was not measured. The data could not explain why some patients continued using opioids or describe the prescribers who wrote the prescriptions. Patients had to be community dwelling for at least 30 days in the first four months after fracture, so chronically institutionalized patients were excluded and the cohort may be healthier. Only filled outpatient prescriptions were counted, so actual consumption, diversion and inpatient or rehabilitation fills were not captured. The first month was excluded because of missing data. The study could not measure daily opioid dose intensity. The study could not tell whether opioid prescribing was appropriate, because pain and need vary and the correct rate after fracture is unknown.
Declared interests
The authors declared no conflicts of interest. The supplied publication types indicate NIH extramural research support.
The easy way to misread this
Do not read the 3.8% to 6.4% one-year opioid use as proof that patients were dependent or that prescribing was wrong. The study counted filled prescriptions only, had no non-fracture comparison group, and could not assess appropriateness.