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Am J Health Syst Pharm. 2019 Aug 1;76(16):1231-1237. doi: 10.1093/ajhp/zxz092.

Inappropriate opioid prescribing practices: A narrative review.

Author information

1
Department of Medicine, University of British Columbia, Vancouver, Canada, and St. Paul's Hospital, Vancouver, Canada.
2
Department of Medicine, University of British Columbia, Vancouver, Canada, and British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, Canada.
3
British Columbia Centre on Substance Use, Vancouver, Canada, and Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
4
Pharmacy Department, Providence Health Care, St. Paul's Hospital, Vancouver, Canada, and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
5
British Columbia Centre on Substance Use, Vancouver, Canada, and Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

Abstract

PURPOSE:

Results of a literature review to identify indicators of inappropriate opioid prescribing are presented.

SUMMARY:

While prescription opioids can be effective for the treatment of acute pain, inappropriate prescribing practices can increase the risk of opioid-related harms, including overdose and mortality. To date, little research has been conducted to determine how best to define inappropriate opioid prescribing. Five electronic databases were searched to identify studies (published from database inception to January 2017) that defined inappropriate opioid prescribing practices. Search terms varied slightly across databases but included opioid, analgesics, inappropriate prescribing, practice patterns, and prescription drug misuse. Gray literature and references of published literature reviews were manually searched to identify additional relevant articles. From among the 4,665 identified articles, 41 studies were selected for data extraction and analysis. Fourteen studies identified high-daily-dose opioid prescriptions, 14 studies identified coadministration of benzodiazepines and opioids, 10 studies identified inappropriate opioid prescribing in geriatric populations, 8 studies identified other patient-specific factors, 4 studies identified opioid prescribing for the wrong indication, and 4 studies identified factors such as initiation of long-acting opioids in opioid-naive patients as indicators of inappropriate opioid prescribing.

CONCLUSION:

A literature review identified various indicators of inappropriate opioid prescribing, including the prescribing of high daily doses of opioids, concurrent benzodiazepine administration, and geriatric-related indicators. Given the significant contribution of inappropriate opioid prescribing to opioid-related harms, identification of these criteria is important to inform and improve opioid prescribing practices among healthcare providers.

KEYWORDS:

opioid epidemic; prescription opioids; risk management

PMID:
31251321
DOI:
10.1093/ajhp/zxz092

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