New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID-19

Samantha Harrison; Krystal Capers; Guanqing Chen; Ji T Liu; Ameeka Pannu; Valerie Goodspeed; Akiva Leibowitz; Somnath Bose

doi:10.1002/jhm.13408

New initiation of opioids, benzodiazepines and antipsychotics following hospitalization for COVID-19

J Hosp Med. 2024 May 14. doi: 10.1002/jhm.13408. Online ahead of print.

Authors

Samantha Harrison^{1

2}, Krystal Capers^{1

2}, Guanqing Chen^{1

2}, Ji T Liu³, Ameeka Pannu¹, Valerie Goodspeed^{1

2}, Akiva Leibowitz¹, Somnath Bose^{1

2}

Affiliations

¹ Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
² Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Center for Anesthesia Research Excellence (CARE), Boston, Massachusetts, USA.
³ Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

PMID: 38742528
DOI: 10.1002/jhm.13408

Abstract

Background: Patients newly initiated on opioids (OP), benzodiazepines (BZD), and antipsychotics (AP) during hospitalization are often prescribed these on discharge. Implications of this practice on outcomes remains unexplored.

Objective: To explore the prevalence and risk factors of new initiation of select OP, BZD and AP among patients requiring in-patient stays. Test the hypothesis that new prescriptions are associated with higher odds of readmission or death within 28 days of discharge.

Design: Single center retrospective cohort study.

Setting and participants: Patients admitted to a tertiary-level medical center with either a primary diagnosis of RT-PCR positive for COVID-19 or high index of clinical suspicion thereof.

Intervention: None.

Main outcome and measures: Exposure was the new initiation of select common OP, BZD, and AP which were continued on hospital discharge. Outcome was a composite of 28-day readmission or death following index admission. Multivariable logistic regression was used to assess patient mortality or readmission within 28 days of discharge associated with new prescriptions at discharge.

Results: One thousand three hundred and nineteen patients were included in the analysis. 11.3% (149/1319) were discharged with a new prescription of select OP, BZD, or AP either alone or in combination. OP (110/149) were most prescribed followed by BZD (41/149) and AP (22/149). After adjusting for unbalanced confounders, new prescriptions (adjusted odds ratio: 2.44, 95% confidence interval: 1.42-4.12; p = .001) were associated with readmission or death within 28 days of discharge. One in nine patients admitted with a diagnosis of COVID-19 or high clinical suspicion thereof were discharged with a new prescription of either OP, BZD or AP. New prescriptions were associated with higher odds of 28-day readmission or death. Strengthening medication reconciliation processes focused on these classes may reduce avoidable harm.