Decreasing Trends in Opioid Prescribing on Discharge to Hospice Care

UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Epidemiology | Health Services Administration | Health Services Research | Pain Management | Pharmacy and Pharmaceutical Sciences


CONTEXT: There are concerns that policies aimed to prevent opioid misuse may unintentionally reduce access to opioids for patients at end-of-life.

OBJECTIVE: We assessed trends in opioid prescribing among patients on discharge from the hospital to hospice care.

METHODS: This was a retrospective cohort study among adult (age > /=18 years) patients discharged from a 544-576 bed, academic medical center to hospice care between January 1, 2010 to December 31, 2018. Study data were collected from a repository of patients' electronic health record data. Our primary outcome was the frequency of opioid prescribing on discharge to hospice care. Our primary exposure was the calendar year of discharge. We also investigated non-opioid analgesic prescribing and stratified opioid prescribing trends by patient characteristics (e.g., demographics, cancer diagnosis, and location of hospice care).

RESULTS: Among 2,648 discharges to hospice care, mean (standard deviation) age was 65.8 (16.0) years, 46.3% were female, and 58.7% had a cancer diagnosis. Opioid prescribing on discharge to hospice care decreased significantly from 91.2% (95% confidence interval (CI) = 87.1%-94.1%) in 2010 to 79.3% (95% CI = 74.3%-83.5%) in 2018 adjusting for age, sex, cancer diagnosis, and location of hospice care. Prescribing of non-opioid analgesic medications increased over the same time period.

CONCLUSIONS: We observed a statistically significant decreasing trend in opioid prescribing on discharge to hospice care. Further research should aim to confirm these findings and to identify opportunities to ensure optimal pain management among patients transitioning to hospice care.


Hospice care, opioids, pain management, transitions of care

DOI of Published Version



Furuno JP, Noble BN, Fromme EK, Hartung DM, Tjia J, Lynn M, Teno JM. Decreasing Trends in Opioid Prescribing on Discharge to Hospice Care. J Pain Symptom Manage. 2021 Nov;62(5):1026-1033. doi: 10.1016/j.jpainsymman.2021.03.025. Epub 2021 Apr 10. PMID: 33848567; PMCID: PMC8502178. Link to article on publisher's site

Journal/Book/Conference Title

Journal of pain and symptom management

PubMed ID


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Link to Article in PubMed