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We read with great interest the consensus statement on improving the safety of opioid use for acute noncancer pain by Herzig et al.1 We strongly support the recommendations outlined in the document.
However, we would like to advocate for an additional recommendation that was considered but not included by the authors. Given the proven benefit—with minimal risk—in providing naloxone to patients and family members, we encourage naloxone prescriptions at discharge for all patients at risk for opioid overdose independent of therapy duration.2 Even opioid-naive patients who are prescribed opioids at hospital discharge have a significantly higher risk for chronic opioid use.3
We support extrapolating recommendations from the Centers for Disease Control and Prevention and Substance Abuse and Mental Health Services Administration to prescribe naloxone to all patients at discharge who are at risk for an opioid overdose, including those with a history of overdose or substance use disorder as well as those receiving a prescription of ≥50 mg morphine equivalents per day or who use opioids and benzodiazepines.4,5
Given the current barriers to healthcare access, prescribing naloxone at discharge may be a rare opportunity to provide a potential life-saving intervention to prevent a fatal opioid overdose.
Disclosures
We have no relevant conflicts of interest to report. No payment or services from a third party were received for any aspect of this submitted work. We have no financial relationships with entities in the biomedical arena that could be perceived to influence, or that give the appearance of potentially influencing, what was written in this submitted work.
1. Herzig SJ, Mosher HJ, Calcaterra SL, Jena AB, Nuckols TK. Improving the safety of opioid use for acute noncancer pain in hospitalized adults: a consensus statement from the society of hospital medicine. J Hosp Med. 2018;13(4);263-271. doi: 10.12788/jhm.2980. PubMed
2. McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction 2016;111(7):1177-1187. doi: 10.1111/add.13326. PubMed
3. Calcaterra SL, Yamashita TE, Min SJ, Keniston A, Frank JW, Binswanger IA. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2016;31(5):478-485. doi: 10.1007/s11606-015-3539-4. PubMed
4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA. 2016;315(15):1624-1645. doi: 10.1001/jama.2016.1464. PubMed
5. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 18- 5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. Available at: https://store.samhsa.gov/shin/content//SMA18-5063FULLDOC/SMA18-5063FULLDOC.pdf. Accessed April 12, 2018.
We read with great interest the consensus statement on improving the safety of opioid use for acute noncancer pain by Herzig et al.1 We strongly support the recommendations outlined in the document.
However, we would like to advocate for an additional recommendation that was considered but not included by the authors. Given the proven benefit—with minimal risk—in providing naloxone to patients and family members, we encourage naloxone prescriptions at discharge for all patients at risk for opioid overdose independent of therapy duration.2 Even opioid-naive patients who are prescribed opioids at hospital discharge have a significantly higher risk for chronic opioid use.3
We support extrapolating recommendations from the Centers for Disease Control and Prevention and Substance Abuse and Mental Health Services Administration to prescribe naloxone to all patients at discharge who are at risk for an opioid overdose, including those with a history of overdose or substance use disorder as well as those receiving a prescription of ≥50 mg morphine equivalents per day or who use opioids and benzodiazepines.4,5
Given the current barriers to healthcare access, prescribing naloxone at discharge may be a rare opportunity to provide a potential life-saving intervention to prevent a fatal opioid overdose.
Disclosures
We have no relevant conflicts of interest to report. No payment or services from a third party were received for any aspect of this submitted work. We have no financial relationships with entities in the biomedical arena that could be perceived to influence, or that give the appearance of potentially influencing, what was written in this submitted work.
We read with great interest the consensus statement on improving the safety of opioid use for acute noncancer pain by Herzig et al.1 We strongly support the recommendations outlined in the document.
However, we would like to advocate for an additional recommendation that was considered but not included by the authors. Given the proven benefit—with minimal risk—in providing naloxone to patients and family members, we encourage naloxone prescriptions at discharge for all patients at risk for opioid overdose independent of therapy duration.2 Even opioid-naive patients who are prescribed opioids at hospital discharge have a significantly higher risk for chronic opioid use.3
We support extrapolating recommendations from the Centers for Disease Control and Prevention and Substance Abuse and Mental Health Services Administration to prescribe naloxone to all patients at discharge who are at risk for an opioid overdose, including those with a history of overdose or substance use disorder as well as those receiving a prescription of ≥50 mg morphine equivalents per day or who use opioids and benzodiazepines.4,5
Given the current barriers to healthcare access, prescribing naloxone at discharge may be a rare opportunity to provide a potential life-saving intervention to prevent a fatal opioid overdose.
Disclosures
We have no relevant conflicts of interest to report. No payment or services from a third party were received for any aspect of this submitted work. We have no financial relationships with entities in the biomedical arena that could be perceived to influence, or that give the appearance of potentially influencing, what was written in this submitted work.
1. Herzig SJ, Mosher HJ, Calcaterra SL, Jena AB, Nuckols TK. Improving the safety of opioid use for acute noncancer pain in hospitalized adults: a consensus statement from the society of hospital medicine. J Hosp Med. 2018;13(4);263-271. doi: 10.12788/jhm.2980. PubMed
2. McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction 2016;111(7):1177-1187. doi: 10.1111/add.13326. PubMed
3. Calcaterra SL, Yamashita TE, Min SJ, Keniston A, Frank JW, Binswanger IA. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2016;31(5):478-485. doi: 10.1007/s11606-015-3539-4. PubMed
4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA. 2016;315(15):1624-1645. doi: 10.1001/jama.2016.1464. PubMed
5. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 18- 5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. Available at: https://store.samhsa.gov/shin/content//SMA18-5063FULLDOC/SMA18-5063FULLDOC.pdf. Accessed April 12, 2018.
1. Herzig SJ, Mosher HJ, Calcaterra SL, Jena AB, Nuckols TK. Improving the safety of opioid use for acute noncancer pain in hospitalized adults: a consensus statement from the society of hospital medicine. J Hosp Med. 2018;13(4);263-271. doi: 10.12788/jhm.2980. PubMed
2. McDonald R, Strang J. Are take-home naloxone programmes effective? Systematic review utilizing application of the Bradford Hill criteria. Addiction 2016;111(7):1177-1187. doi: 10.1111/add.13326. PubMed
3. Calcaterra SL, Yamashita TE, Min SJ, Keniston A, Frank JW, Binswanger IA. Opioid prescribing at hospital discharge contributes to chronic opioid use. J Gen Intern Med. 2016;31(5):478-485. doi: 10.1007/s11606-015-3539-4. PubMed
4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016. JAMA. 2016;315(15):1624-1645. doi: 10.1001/jama.2016.1464. PubMed
5. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63, Full Document. HHS Publication No. (SMA) 18- 5063FULLDOC. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. Available at: https://store.samhsa.gov/shin/content//SMA18-5063FULLDOC/SMA18-5063FULLDOC.pdf. Accessed April 12, 2018.
© 2018 Society of Hospital Medicine