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Society of Hospital Medicine recommendations for safe opioid use for hospitalized patients
Clinical Question
What are best practices for the safe prescribing of opioids in the hospital setting?
Bottom line
The Society of Hospital Medicine (SHM) developed a consensus statement that provides recommendations, informed by existing guidelines, on safe opioid use for the treatment of acute noncancer pain in hospitalized patients. Given that many of the recommendations were based on expert opinion alone, more research is required to develop high-quality, evidence-based recommendations that focus on the hospital setting. 5
Reference
Study design: Practice guideline
Funding: Foundation
Setting: Inpatient (any location)
Synopsis
The SHM convened a working group to develop a consensus statement on safe opioid prescribing for acute noncancer pain in the hospital. This group searched the National Guideline Clearinghouse, PubMed, websites of specialty societies, and international search engines to find existing guidelines that provided recommendations on opioid prescribing. Excluded were guidelines published prior to 2010, those that focused on chronic pain or pain associated with specific disease processes, and those that focused on care in intensive care units or in specific nonhospital settings such as nursing homes. Most of the recommendations from the 4 selected guidelines were based on expert opinion. Moreover, only 2 of the 4 gave recommendations specific to the hospital setting. The working group extracted recommendations from these guidelines to develop a consensus statement that was then subjected to review by experts on hospital opioid-prescribing, SHM members, leaders of other professional societies, and peer reviewers. Their final consensus statement consists of 16 recommendations, including the following: (1) limit the use of opioids to patients with moderate or severe pain that has not responded to nonopioid therapy, (2) review information from prescription drug-monitoring program databases to inform decision-making about opioids, (3) use the lowest effective opioid dose for the shortest duration possible, (4) avoid long-acting opioid formulations, (5) use oral opioids rather than intravenous opioids whenever possible, and (6) prescribe the minimum quantity of opioids anticipated to be necessary for the treatment of acute pain after discharge.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
Recommendation 4 gives me pause:
(4) avoid long-acting opioid formulations
My work in a convalescent care unit is with patients with complicated fractures. The typical patients are the frail elderly or younger, multiple trauma victims. My understanding and observation is that long-acting opioids give more controlled opioid administrations. Monitoring is easier because the goal is reduce PRN opioid use. Tapering is more pro forma.
Simplistic statements / recommendations will not help us - as a society and a profession - in dealing with the opioid issue.
Usually that’s what we all try to do. In practice depends on many factors, like previous use of narcotics and the level of tolerance or addiction and the multiple psychological and social circumstances accompanying the patient. Sometimes is really difficult to control all of thi variables.
Not enough info to change clinical practice.
good poem
I am retired no Hospital no acute pain but I used the principal with a dose encouragement and assurance.
A group of well matched rats had sciatic nerve compression. Half received five days of morphine following this, the other half did not. The rats who received morphine for five days were still limping after two months, those who did not stopped limping at one month. It appears narcotics prolong pain duration. As far as pain control, they appear to be counterproductive in the long run.