2025 Southeastern Residency Conference

Title: Chronic Opioid Use Post ICU Exposure in Opioid Naive Patients


Authors: Hillary Anne Reeves, PharmD; Caitlin Thomas, PharmD, BCCCP


Objective: To assess the prevalence of opioid prescribing and post-discharge opioid use in opioid-naive ICU patients who received scheduled opioids during invasive mechanical ventilation (IMV) weaning. This study aims to identify risk factors for prolonged opioid use and guide opioid stewardship interventions.


Self-Assessment Question: Which of the following best describes a concern associated with the use of opioids for weaning patients from IMV?


1. Opioids used during weaning are often underdosed, leading to withdrawal symptoms.

2. Opioid use during weaning may predispose previously opioid-naïve patients to new prescriptions at discharge and long-term use.

3. Use of opioids during IMV can lead to inadequate sedation and poor weaning outcomes.

4. Opioids are no longer recommended for use in ICU settings due to high misuse rates.

Background: Opioid prescribing in hospitalized patients, particularly those in intensive care units (ICUs), is an area of growing concern due to its potential impact on long-term opioid use. While opioids are commonly used to facilitate weaning from IMV by providing sedation and analgesia, there is limited understanding of their role in continued opioid use after discharge, especially in opioid-naive patients. This study aims to evaluate the practice patterns of opioid prescribing and post-discharge opioid use during IMV weaning. The findings from this study may help guide opioid stewardship efforts and inform strategies for optimizing pain management while minimizing opioid exposure in critically ill patients.


Methods: This is a single-center, retrospective cohort study that has been deemed a quality improvement project and exempt from IRB approval. The study evaluated opioid prescribing patterns in opioid-naive ICU patients who received scheduled opioids during IMV weaning at a large, tertiary level, community teaching hospital. The electronic medical record (EMR) and Prescription Drug Monitoring Program (PDMP) will be used to evaluate opioid prescribing patterns at discharge and outpatient use. Patients > 18 years old admitted to the ICU, mechanically ventilated for > 3 days, and receiving scheduled opioids during IMV weaning will be included. Patients are excluded if they have a documented history of chronic opioid use or opioid use disorder prior to ICU admission, patients discharged to hospice or palliative care, major surgery at any point during admission, or incomplete medical records that do not provide sufficient data for analysis. EMR data from January 2023 -December 2023 will assess opioid initiation in the ICU, with PDMP review for up to 1-year post-discharge to evaluate outpatient opioid use. This study will compare patients who received scheduled opioids during IMV weaning to those who did not, identifying factors associated with outpatient prescribing and long-term opioid use. 


Results: A total of 531 patients were screened, resulting in 58 patients who met inclusion criteria. Of these, 47 patients comprised the comparator group (no scheduled opioids during weaning), while 11 patients made up the study group (received scheduled opioids during weaning). The primary outcome showed no statistically significant difference (p=1.00) in the number of patients discharged with an opioid prescription between the two groups. Six patients in the comparator group were discharged with an opioid prescription, compared to one patient in the study group.


Conclusions: This study explored the relationship between scheduled opioid administration during invasive mechanical ventilation (IMV) weaning and subsequent outpatient opioid prescribing in opioid-naïve ICU patients. Although the study was underpowered, the results did not show a significant increase in discharge opioid prescribing among patients who received scheduled opioids during IMV weaning compared to those who did not. These findings suggest that current prescribing practices at our institution may reflect appropriate tapering or discontinuation of opioids prior to discharge, even among patients exposed to scheduled opioids during their ICU stay.