One in six admitted patients with low back pain received high daily opioid dosage in Australian hospitals: a cross-sectional study

AIM: To examine the amount of opioids administered to patients with low back pain in the hospital setting and to determine factors associated with high daily dosage. METHODS: This cross-sectional study analysed medical records of three public hospitals in Sydney, NSW, Australia. We included adult patients who presented to the emergency department (ED) from January 2016 to October 2021 with non-specific low back pain or radiculopathy. The opioid dose administered in the ED and the daily dosage during hospital stay (if admitted) were estimated using opioid orders measured by milligram of morphine equivalents (MME). High-dose opioid therapy was defined as ≥ 50 MME/day during hospital stay. RESULTS: Of the 9,345 eligible ED encounters, we included 12,850 opioid orders placed for 5,132 patients (54.9%). Among the 7,633 patients discharged home from ED, 3,519 patients (46.1%) were administered opioids in the ED at an average dose of 13.9 MME (SD = 35.6). 94.2% of patients who were admitted to hospitals (1,613 out of 1,712) received a mean dosage of 34.7 MME/day (SD = 68.3), including 154 patients (9.0%) received 50-90 MME/day and 117 (6.8%) received ≥ 90 MME/day. High-dose opioid therapy was associated with younger age (aOR = 0.80, 95% CI 0.74-0.85), male gender (aOR = 1.38, 95% CI 1.05-1.81), disadvantaged socio-economic status (aOR = 1.50, 95% CI 1.07-2.10), and serious pathology diagnosed during hospital admission (aOR = 1.79, 95% CI 1.36-2.37). CONCLUSION: Almost one in six admitted patients with low back pain receive a high daily opioid dosage in Australian hospitals. Strategies implementing evidence-based non-opioid alternatives to reduce high-dose opioid therapy are warranted.