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Risk Factors for Opioid Utilization in Patients with Intracerebral Hemorrhage

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Abstract

Background

Headache is a common presenting symptom of intracerebral hemorrhage (ICH) and often necessitates treatment with opioid medications. However, opioid prescribing patterns in patients with ICH are not well described. We aimed to characterize the prevalence and risk factors for short and longer-term opioid use in patients with ICH.

Methods

We conducted a retrospective cohort study using data from a single-center registry of patients with nontraumatic ICH. This registry included data on demographics, ICH-related characteristics, and premorbid, inpatient, and postdischarge medications. After excluding patients who died or received end-of-life care, we used multivariable regression models adjusted for premorbid opioid use to determine demographic and ICH-related risk factors for inpatient and postdischarge opioid use.

Results

Of 468 patients with ICH in our cohort, 15% (n = 70) had premorbid opioid use, 53% (n = 248) received opioids during hospitalization, and 12% (n = 53) were prescribed opioids at discharge. The most commonly used opioids during hospitalization were fentanyl (38%), oxycodone (30%), morphine (26%), and hydromorphone (7%). Patients who received opioids during hospitalization were younger (univariate: median [interquartile range] 64 [53.5–74] vs. 76 [67–83] years, p < 0.001; multivariable: odds ratio [OR] 0.96 per year, 95% confidence interval [CI] 0.94–0.98) and had larger ICH volumes (univariate: median [interquartile range] 10.1 [2.1–28.6] vs. 2.7 [0.8–9.9] cm3, p < 0.001; multivariable: OR 1.05 per cm3, 95% CI 1.03–1.08) than those who did not receive opioids. All patients who had external ventricular drain placement and craniotomy/craniectomy received inpatient opioids. Additional risk factors for increased inpatient opioid use included infratentorial ICH location (OR 4.8, 95% CI 2.3–10.0), presence of intraventricular hemorrhage (OR 3.9, 95% CI 2.2–7.0), underlying vascular lesions (OR 3.0, 95% CI 1.1–8.1), and other secondary ICH etiologies (OR 7.5, 95% CI 1.7–32.8). Vascular lesions (OR 4.0, 95% CI 1.3–12.5), malignancy (OR 5.0, 95% CI 1.5–16.4), vasculopathy (OR 10.0, 95% CI 1.8–54.2), and other secondary etiologies (OR 7.2, 95% CI 1.8–29.9) were also risk factors for increased opioid prescriptions at discharge. Among patients who received opioid prescriptions at discharge, 43% (23 of 53) continued to refill their prescriptions at 3 months post discharge.

Conclusions

Inpatient opioid use in patients with ICH is common, with some risk factors that may be mechanistically connected to primary headache pathophysiology. However, the lower frequency of opioid prescriptions at discharge suggests that inpatient opioid use does not necessarily lead to a high rate of long-term opioid dependence in patients with ICH.

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References

  1. Clark DJ, Schumacher MA. America’s opioid epidemic: supply and demand considerations. Anesth Analg. 2017;125(5):1667–74.

    Article  Google Scholar 

  2. Rudd RA, Puja S, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65(50–51):1445–52.

    Article  Google Scholar 

  3. Sites BD, Beach ML, Davis MA. Increases in the use of prescription opioid analgesics and the lack of improvement in disability metrics among users. Reg Anesth Pain Med. 2014;39(1):6–12.

    Article  Google Scholar 

  4. Volkow ND, McLellan AT. Opioid abuse in chronic pain—misconceptions and mitigation strategies. New Engl J Med. 2016;374(13):1253–63.

    Article  CAS  Google Scholar 

  5. Pierce DPR, Pierce B, Cheng CI, Perzhinsky J. Assessing treatment and monitoring of musculoskeletal conditions using opioid versus nonopioid therapy: a cross-sectional study. Medicine (Baltimore). 2019;98(15):e15128.

    Article  Google Scholar 

  6. Kleindorfer DO, Miller R, Moomaw CJ, et al. Designing a message for public education regarding stroke: does FAST capture enough stroke? Stroke. 2007;38(10):2864–8.

    Article  Google Scholar 

  7. Mahta A, Anderson MN, Azher AI, et al. Short- and long-term opioid use in survivors of subarachnoid hemorrhage. Clin Neurol Neurosurg. 2021;207:106770.

    Article  Google Scholar 

  8. Jaffa MN, Podell JE, Smith MC, et al. Association of refractory pain in the acute phase after subarachnoid hemorrhage with continued outpatient opioid use. Neurology. 2021;96(19):e2355–62.

    Article  CAS  Google Scholar 

  9. Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):1304–5.

    Article  CAS  Google Scholar 

  10. 2018 American Community Survey 1-Year Estimates Table S1901, in American Community Survey2018, United States Census Bureau.

  11. HCUP NIS Description of Data Elements. Healthcare Cost and Utilization Project (HCUP). 2019. Available from: https://www.hcup-us.ahrq.gov/db/vars/zipinc_qrtl/nisnote.jsp.

  12. Hesami O, Gharagozli K, Beladimoghadam N, et al. The efficacy of gabapentin in patients with central post-stroke pain. Iran J Pharm Res. 2015;14(Suppl):95–101.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Dhakal LP, Hodge DO, Nagal J, et al. Safety and tolerability of gabapentin for aneurysmal subarachnoid hemorrhage (SAH) headache and meningismus. Neurocrit Care. 2015;22(3):414–21.

    Article  CAS  Google Scholar 

  14. Kalita J, Misra U, Kumar A, Bhoi SK. Long-term prednisolone in post-stroke complex regional pain syndrome. Pain Physician. 2016;19(8):565–74.

    Article  Google Scholar 

  15. Memis D, Inal MT, Kavalci G, Sezer A, Sut N. Intravenous paracetamol reduced the use of opioids, extubation time, and opioid-related adverse effects after major surgery in intensive care unit. J Crit Care. 2010;25(3):458–62.

    Article  CAS  Google Scholar 

  16. Subramaniam B, Shankar P, Shaefi S, et al. Effect of intravenous acetaminophen vs placebo combined with propofol or dexmedetomidine on postoperative delirium among older patients following cardiac surgery: the DEXACET randomized clinical trial. JAMA. 2019;321(7):686–96.

    Article  CAS  Google Scholar 

  17. Xu XM, Luo H, Rong BB, et al. Nonpharmacological therapies for central poststroke pain: a systematic review. Medicine (Baltimore). 2020;99(42):e22611.

    Article  CAS  Google Scholar 

  18. Darnall BD, Stacey BR. Sex differences in long-term opioid use: cautionary notes for prescribing in women. Arch Int Med. 2012;172(5):431–2.

    Article  Google Scholar 

  19. Cicero TJ, Wong G, Tian Y, et al. Co-morbidity and utilization of medical services by pain patients receiving opioid medications: data from an insurance claims database. Pain. 2009;144(1–2):20–7.

    Article  Google Scholar 

  20. Herr KA, Garand L. Assessment and measurement of pain in older adults. Clin Geriatr Med. 2001;17(3):457–78.

    Article  CAS  Google Scholar 

  21. Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010;10(3):179–87.

    PubMed  PubMed Central  Google Scholar 

  22. Adewumi AD, Maravilla JC, Alati R, et al. Duration of opioid use and association with socioeconomic status, daily dose and formulation: a two-decade population study in Queensland. Australia Int J Clin Pharm. 2021;43(2):340–50.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA

    Nelson Lin, Daniel Mandel, Carlin C. Chuck, Savannah R. Doelfel, Helen Zhou, Hari Dandapani, Christoph Stretz, Linda C. Wendell, Bradford B. Thompson, Karen L. Furie, Ali Mahta & Michael E. Reznik

  2. Icahn School of Medicine at Mount Sinai, New York City, NY, USA

    Roshini Kalagara

  3. Department of Pharmacy, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Brown University, 593 Eddy St, APC 712, Providence, RI, USA

    Leana N. Mahmoud

  4. Department of Neurology, Duke University School of Medicine, Duke University, Durham, NC, USA

    Brian C. Mac Grory

  5. Department of Neurosurgery, Warren Alpert Medical School of Brown University, Brown University, Providence, RI, USA

    Linda C. Wendell, Bradford B. Thompson, Ali Mahta & Michael E. Reznik

Authors
  1. Nelson Lin
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  2. Daniel Mandel
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  3. Carlin C. Chuck
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  4. Roshini Kalagara
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  5. Savannah R. Doelfel
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  6. Helen Zhou
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  7. Hari Dandapani
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  8. Leana N. Mahmoud
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  9. Christoph Stretz
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  10. Brian C. Mac Grory
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  11. Linda C. Wendell
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  12. Bradford B. Thompson
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  13. Karen L. Furie
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  14. Ali Mahta
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  15. Michael E. Reznik
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Contributions

Mr. Lin and Dr. Reznik conceived and designed the study, acquired, analyzed, and interpreted data, and drafted and revised the article for intellectual content. Drs. Mandel and Mac Grory, Mr. Chuck, Ms. Kalagara, Ms. Doelfel, Ms. Zhou, and Mr. Dandapani acquired/interpreted data and revised the article for intellectual content. Drs. Mahmoud, Stretz, Wendell, Thompson, Furie, and Mahta critically revised the article for intellectual content. All authors approval of the final version to be submitted.

Corresponding author

Correspondence to Michael E. Reznik.

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None of the authors have any relevant conflicts of interest to disclose.

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Ethical guidelines were adhered to for this retrospective study, with details on institutional review board approval in the article.

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Lin, N., Mandel, D., Chuck, C.C. et al. Risk Factors for Opioid Utilization in Patients with Intracerebral Hemorrhage. Neurocrit Care 36, 964–973 (2022). https://doi.org/10.1007/s12028-021-01404-z

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  • DOI: https://doi.org/10.1007/s12028-021-01404-z

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