Hydrocodone is now the most commonly prescribed medication in the United States. And, your patients will abuse it.
This small study is a prospective follow-up of 85 patients discharged from an urban Emergency Department in Rhode Island. All patients were prescribed an opiate pain reliever – mostly hydrocodone and oxycodone. The authors followed them up at 3 and 30 days to evaluate for self-reported misuse, as well as other clinical characteristics that might predict misuse.
At 30 days, 42% reported they had misused the opiates as prescribed. The most common misuse, described by 92% of misusers, was exceeding the prescribed dose. Half of those exceeding the prescribed dose also exceeded the daily recommended limit of acetaminophen. An additional 39% of misuse patients took opiates diverted from another source, and another 36% stated they used surplus opiates recreationally. Patients with pre-existing disability, chronic pain, and prior opiate use were the most likely to misuse. Any non-zero risk category on the Drug Abuse Screening Test (DAST-10) gave an odds ratio of 18 for misuse, compared with those who received opiates but did not misuse.
This study is limited in its generalizability and has other bias issues associated with enrollment. However, it is yet another window into what happens to the opiates we inject in the healthcare ecosystem and our need for judicious prescribing.
“Prescription opioid misuse among ED patients discharged with opioids”
http://www.ncbi.nlm.nih.gov/pubmed/24726759