• Erik von Oelreich, Mikael Eriksson, Karl-Fredrik Sjölund, Andrea Discacciati, Emma Larsson, and Anders Oldner.
• Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.
• Crit. Care Med. 2021 Mar 1; 49 (3): 462471462-471.

ObjectiveTo describe opioid use after ICU admission, identify factors associated with chronic opioid use after critical care, and determine if chronic opioid use is associated with an increased risk of death.DesignRetrospective cohort study.SettingSweden including all registered ICU admissions between 2010 and 2018.PatientsAdults surviving the first two quarters after ICU admission were eligible for inclusion. A total of 265,496 patients were screened and 61,094 were ineligible.InterventionsAdmission to intensive care.Measurements And Main ResultsAmong 204,402 individuals included in the cohort, 22,138 developed chronic opioid use following critical care. Mean opioid consumption peaked after admission followed by a continuous decline without returning to baseline during follow-up of 24 months. Factors associated with chronic opioid use included high age, female sex, presence of comorbidities, preadmission opioid use, and ICU length of stay greater than 2 days. Adjusted hazard ratio for death 6-18 months after admission for chronic opioid users was 1.7 (95% CI, 1.6-1.7; p < 0.001). In the subset of patients not using opioids prior to admission, similar findings were noted.ConclusionsMean opioid consumption is increased 24 months after ICU admission despite the lack of evidence for long-term opioid treatment. Given the high number of ICU entries and risk of excess mortality for chronic users, preventing opioid misuse is important when improving long-term outcomes after critical care.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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