2026 Southeastern Residency Conference

Background: Opioids are analgesic medications that are commonly used for the management of moderate to severe pain. In hospitalized patients, opioid administration carries risks including respiratory depression, delirium, constipation, and potential long-term dependence, with opioid-naïve individuals being particularly at risk for adverse outcomes when exposed. While opioids are appropriate for moderate to severe acute pain, inpatient prescribing frequently occurs without documented acute pain indications. Characterizing opioid use in this population represents an important opportunity for opioid stewardship and quality improvement. 
Methods: This single-center, retrospective observational study evaluated opioid-naïve adult patients admitted to medical floors at a community teaching hospital between September 2024 and October 2025. Patients were included if they were ≥18 years of age, admitted to selected medical floors for at least 24 hours, had the “Admit to Med Surg” orderset added within 24 hours of admission, and opioid-naïve based on medication history and insurance claims data. Patients were excluded if they had operative procedures requiring anesthesia, chronic pain, acute pain indications, active cancer, opioid use disorder, pregnancy, incarceration, or enrollment in hospice or palliative care. Eligible patients were grouped based on patients with the as-needed (PRN) pain orders and patients without the PRN pain orders within the “Admit to Med Surg” orderset. The primary outcome was inpatient opioid exposure, measured in morphine milligram equivalents (MME), during the first seven days of hospitalization. Secondary outcomes included the rate of patients who received over the first seven days of admission, opioid prescription at discharge (MME and duration) and opioid-related adverse events requiring naloxone administration or intubation.  
Results: A total of 198 patients were included (65 with PRN pain orders, 133 without PRN pain orders). Mean opioid exposure over the first seven days of admission was significantly higher in patients with an PRN pain orders compared to those without (p<0.001, 95% CI 1.66(1.4997 - 1.8203)). For secondary outcomes, 61.5% of patients with the opioid orders received at least one dose of opioid medication, and only 17.2% of patients without the opioid orders received an opioid medication during admission. There was no difference between groups in opioid-related adverse events requiring naloxone.  Discharge opioid prescribing rates showed 4.6% of patients received a prescription in the group with the PRN pain orders compared to only 0.6% of patients without the PRN pain orders received an prescription for an opioid at discharge. Of patients who received a prescription at discharge, the average days supply of 3.67 days in the group with the PRN pain orders with an average MME of 80, whereas the group without the PRN pain orders had an average days supply of 2 with average MME of 75.  
Conclusion: Opioid-naïve patients without acute pain indications who had an PRN pain orders within 24 hours of admission experienced significantly higher inpatient opioid exposure at 7 days than those without. These findings highlight an opportunity for standardizing pain management strategies to help minimize unintended opioid exposure in this population.