Incidence and duration of hospital-initiated opioids, benzodiazepines and antipsychotics: a retrospective cohort study

INTRODUCTION: Many patients receive temporarily indicated medications, such as opioids, benzodiazepines, and antipsychotics (potentially inappropriate medications (PIMs) of interest) in hospitals. This could result in PIM use thereafter, when medication is continued. AIM: This study aimed to investigate the incidence and duration of hospital-initiated PIM use. METHOD: This retrospective cohort study included patients aged ≥ 18 years who visited a Dutch teaching hospital between January 2019-May 2023 and received a new prescription for an opioid, benzodiazepine, or antipsychotic initiated at discharge or outpatient visit and continued thereafter. Patients were followed for one year using data from the hospital's information system and community pharmacy dispensing records. The primary outcomes were the incidence of PIMs of interest and duration of use. Secondary outcomes included duration of PIM use across age categories and the proportion of prescriptions classified as actually inappropriate medication based on the documented indications in a subset of patients. Descriptive data analysis was used. Chi-square tests were used to assess differences between age categories and duration of continued use. RESULTS: Among 6,835 patients with a new prescription of one of the medications, 82.7% were prescribed and dispensed an opioid (n = 5,652, mean age 61.1 years, 57.3% female), 14.7% a benzodiazepine (n = 1,005, mean age 60.7 years, 53.3% female) and 2.6% an antipsychotic (n = 178, mean age 69.2 years, 48.9% female). A significant proportion used the medication > 182 days following the hospital visit (13.4% opioids, 20.9% benzodiazepine, 36.0% of antipsychotics). PIMs were not more frequently discontinued in older adults. Among 156 randomly evaluated prescriptions, a clear justification for continued use was often lacking, mainly for benzodiazepines (83.1%) and opioids (76.0%). CONCLUSION: Potentially temporarily indicated medications were often continued following a hospital visit without justification for continued use. These results highlight the importance of carefully assessing the timely discontinuation or specifying a discontinuation date for PIMs.