Opioid-Related Hospitalization and Its Association With Chronic Diseases

Findings From the National Inpatient Sample, 2011-2015

Janani Rajbhandari-Thapa, PhD; Donglan Zhang, PhD; Heather M Padilla, PhD; Sae Rom Chung, MS

Disclosures

Prev Chronic Dis. 2019;16(11):e157 

In This Article

Discussion

We found that more than 90% of opioid-related hospitalizations were among patients with 2 or more chronic diseases and that the trend in opioid-related hospitalization among patients with chronic diseases is increasing. This finding is salient given that 1 in 4 US adults are living with 2 or more chronic diseases.[13] Both the opioid crisis and rising rates of chronic disease have been described as epidemics; however, they are currently being treated separately. The US Department of Health and Human Services' 5-point strategy to combat the opioid crisis focuses on the treatment of addiction, which is important for addressing the epidemic in the short term.[14] A population-level approach to preventing and treating chronic diseases is also needed. Health services must address the 2 issues — opioid misuse and management of chronic disease — simultaneously.

Using alternative approaches to pain management is one public health strategy for addressing the opioid crisis[15] and is consistent with the Centers for Disease Control and Prevention's (CDC's) Guideline for Prescribing Opioids for Chronic Pain.[16] Based on our findings, this approach may be particularly important in patients with multiple chronic diseases. Consistent with the CDC guideline, nonpharmacologic treatment including exercise therapy and cognitive behavioral therapy, as well as multimodal therapies combining exercise therapy with psychologically based approaches, should be used to decrease pain and improve functional ability.[16] When opioids are used for pain management, patients with multiple chronic diseases may require close monitoring and additional education on risks of misuse.

This study has several limitations. Because we analyzed data from 2011 to 2015, our findings are not generalizable to more recent years. Our analysis was cross-sectional and examined the associations between opioid-related hospitalization and chronic diseases without controlling for covariates, which prevents us from drawing causal conclusions about the direction of the observed relationship. Furthermore, the nature of the data did not allow us to explore why the associations were not significant in some years. Opioid prescriptions for patients with arthritis have increased in recent years, so that could be an explanation for the strong correlation we found.[17] Finally, we studied a small number of chronic diseases and did not assess any diseases related to mental health.

Despite these limitations, our findings show an increasing trend in opioid-related hospitalization among patients with chronic diseases and a high prevalence of opioid-related hospitalization among patients with multiple chronic conditions. The observed association warrants further research to determine causal inference. Results from this study can help clinicians develop strategies to prevent opioid misuse in patients with multiple chronic conditions and inform strategies for addressing both the opioid epidemic and rising rates of chronic disease.

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