Effect of Fentanyl Exposure on High-Dose Opioid Use Upon Discharge

Sunday, March 22, 2026

11:00 AM - 12:00 PM Central Time

Location: Connections Central - RST 08

Stephanie Lee, PharmD (she/her/hers)

University of California Davis

Disclosure(s): No relevant financial relationship(s) to disclose.
LS

Lydia Shen, PharmD

PGY2 Critical Care Resident
Stanford Health Care

Disclosure information not submitted.
CG

Christian Gage, MD

Surgical Critical Care Fellow
University of California Davis Medical Center

Disclosure information not submitted.
CC

Christine Cocanour, MD, FACS, FCCM

Distinguished Professor of Clinical Surgery
University of California Davis Medical Center

Disclosure information not submitted.
Jeremiah Duby, BCCCP, BCPS, PharmD

University of California Davis Medical Center, California

Disclosure information not submitted.

Introduction: Opioids are commonly administered for acute pain in critically ill trauma patients. In previous studies, opioid exposures greater than 50 oral morphine equivalents (OMEs) were associated with higher risk of outpatient misuse . The objective of this study was to describe the relationship between inpatient opioid exposure and high-risk opioid prescription at discharge in critically ill trauma patients.

Methods: This was a single-center, case-control study at a large academic medical center. Adult trauma patients who were admitted to the ICU (1/1/2024 to 12/31/2024) and received fentanyl continuous infusions for at least 48 hours were eligible for inclusion. Patients were excluded if they expired prior to discharge, transferred to another facility, or were incarcerated. Patients were cohorted into High- or Low-risk groups based on OMEs prescribed upon discharge. The High-risk cohort was defined by opioid prescription of 50 OMEs or greater per day. The primary outcome was characteristics of fentanyl exposure (e.g., cumulative dose, infusion rate) associated with high-risk opioid use upon discharge. Secondary outcomes include ICU and hospital length of stay, use of additional options, and multimodal analgesia practices.

Results: There were 159 patients included in the final analysis for the High-risk (n=29) and Low-risk (n=130) cohorts. Overall, the mean age was 45±19.2 years and 72% were male. There were no significant differences in baseline characteristics including prior opioid use. Multimodal analgesia regimens (i.e., acetaminophen, gabapentin, NSAIDs, local anesthetics) were comparable between groups. The High-risk cohort received a higher maximum fentanyl infusion rate compared to the Low-risk cohort (77.4 ± 36.9 vs 59.4 ± 25.1 mcg/hr; p < 0.01). Multivariable regression analysis showed cumulative fentanyl dose >1,350 mcg by day 2 was independently associated with high-risk opioid prescription at discharge (OR 3.23, 95%CI 1.40 - 7.76, p = 0.007).

Conclusions: Cumulative opioid exposure during ICU stay was associated with an increased probability of high-risk opioid prescribing at discharge in trauma patients. Multimodal analgesia, early dose de-escalation, and other strategies to mitigate high-dose opioid infusions may reduce long-term opioid dependence and misuse.