Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study

Patients with substance abuse disorders are at risk for self-directed hospital discharge, which often leads to adverse health outcomes. A recent study featuring PISC Senior Scholar Shoshana Aronowitz, PhD, CRNP, FNP-BC, evaluates the relationship between acute pain and self-directed discharges among patients with opioid-related conditions. Hospitalization data comprised of 7,972 admissions was drawn from acute care hospitals in Philadelphia during 2017. Adult discharges were specifically examined relating to opioid use or poisoning. Results indicate that opioid-use disorder patients are five times more likely than non-opioid use disorder patients to be discharged preemptively. Repeated patterns of self-directed discharge are common for many opioid use disorder patients. Moreover, patients who enter the ED with acute pain diagnoses are nearly twice as likely to complete a self-directed discharge, alluding to a medically unfulfilled need for pain medication. Improved pain management in hospitals has the potential to reduce opioid-related self-directed discharge. The team concludes that “each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain.”

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