Opioid treatment patterns, trajectories, and deprescribing indicators among hospitalised adults in Switzerland, 2020–2024: a multicentre observational cohort study

Background Despite limited evidence for non-cancer pain, opioid use has increased substantially in Europe. We aimed to characterize patterns and treatment trajectories of inpatient opioid use and to identify clinically distinct patient subgroups of heightened risk for opioid-related harm using predefined deprescribing indicators to inform hospital-based stewardship interventions. Methods This five-year, multicenter, longitudinal, observational cohort study across three Swiss tertiary referral centers (2020–2024) included adult inpatient cases with at least one systemic opioid administration during the index hospitalization using linked electronic health record data. Daily morphine milligram equivalents (MMEs) were calculated from medication administration records. Sustained therapy was defined as ≥3 consecutive treatment days. Deprescribing indicators included high-dose therapy (>90 MMEs on the final hospital day), high-risk comorbidities, and concurrent use of central nervous system depressants. Non-cancer opioid treatment trajectories were clustered using k-means analysis. Findings Among 68,129 opioid-treated cases, 78.6% (n = 53,558) had no documented cancer diagnosis. Approximately half received sustained therapy. Collectively, 11.4% (n = 7791) of 68,129 cases met at least one predefined deprescribing indicator. Musculoskeletal disorders and injury-related conditions were the primary admission diagnoses (22.9% [n = 15,575] of 68,129 cases). Opioid treatment trajectory analysis identified three distinct MME patterns among non-cancer cases, including a stable-dose subgroup (36% [n = 19,292] of 53,558) characterized by sustained therapy (89.3% [n = 17,235] of 19,292 cases), higher comorbidity burden, and greater prevalence of deprescribing indicators (33.4% [n = 17,235] of 19,292 cases). Annually, over 1200 cases were eligible for deprescribing, predominantly older adults with musculoskeletal conditions. Interpretation Inpatient opioid exposure was overall more common in non-cancer cases and often characterized by sustained therapy with only marginal dose reductions prior to discharge. Hospitals therefore represent critical intervention points for structured deprescribing approaches to prevent transitions to potentially harmful, persistent opioid use. Funding This research did not receive external funding.