Advertisement

Trends in emergency physician opioid prescribing practices during the United States opioid crisis

  • Ryan Gleber
    Affiliations
    University of California, San Diego Medical Center, Department of Emergency Medicine San Diego, California 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, United States of America
    Search for articles by this author
  • Gary M. Vilke
    Affiliations
    University of California, San Diego Medical Center, Department of Emergency Medicine San Diego, California 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, United States of America
    Search for articles by this author
  • Edward M. Castillo
    Affiliations
    University of California, San Diego Medical Center, Department of Emergency Medicine San Diego, California 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, United States of America
    Search for articles by this author
  • Jesse Brennan
    Affiliations
    University of California, San Diego Medical Center, Department of Emergency Medicine San Diego, California 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, United States of America
    Search for articles by this author
  • Leslie Oyama
    Affiliations
    University of California, San Diego Medical Center, Department of Emergency Medicine San Diego, California 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, United States of America
    Search for articles by this author
  • Christopher J. Coyne
    Correspondence
    Corresponding author at: 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, United States of America.
    Affiliations
    University of California, San Diego Medical Center, Department of Emergency Medicine San Diego, California 200 West Arbor Drive, Mailcode 8676, San Diego, CA 92103, United States of America
    Search for articles by this author

      Abstract

      Background

      Prescription opioid related deaths have increased dramatically over the past 17 years. Although emergency physicians (EPs) have not been the primary force behind this rise, previous literature have suggested that EPs could improve their opioid prescribing practices. We designed this study to evaluate the trend in emergency department (ED) opioid prescriptions over time during the US opioid epidemic.

      Methods

      We conducted a retrospective cohort study from July 1, 2012 to June 30, 2018, evaluating all adult patients who presented to two study EDs for a pain-related complaint and received an analgesic prescription upon ED discharge. We compared these data to trends in lay media and medical literature regarding the opioid epidemic. We also evaluated the incidence of repeat ED visits based on the type of analgesic prescriptions provided.

      Results

      Opioid prescriptions decreased from 37.76% to 13.29% over the six year study period. This coupled with an increase in non-opioid medications from 6.12% to 11.33% and an increase in “no prescription” from 56.12% to 75.37%. This corresponded with an increase in the number of publications on the opioid epidemic within the lay-public and medical literature. Additionally, those patients that received no opiates were less likely to require a repeat ED visit.

      Conclusions

      ED physicians are prescribing less opiates, while increasing the amount of non-narcotic analgesic prescriptions. This may be in response to the literature suggesting that prescription opioids play a large role in the opioids crisis. This decrease in opioid prescriptions did not increase the need for repeat ED visits.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Strader D.
        • Duncan R.
        Colorado opioid safety pilot results report.
        Colorado Hospital Association, 2017
      1. Opioid data analysis. Centers for Disease Control and Prevention, 2018
        • Ahmad F.B.
        • Rossen L.M.
        • Spencer M.R.
        • Warner M.
        • Sutton P.
        Provisional drug overdose death counts.
        National Center for Health Statistics, 2018
        • Guy Jr., G.P.
        • Zhang K.
        • Bohm M.K.
        • et al.
        Vital signs: changes in opioid prescribing in the United States, 2006–2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 697-704
        • Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services
        Results from the 2012 national survey on drug use and health: summary of national findings.
        • Barnett M.
        • Olenski A.
        • Jena A.
        Opioid-prescribing patterns of emergency physicians and risk of long-term use.
        N Engl J Med. 2017; 376: 663-673https://doi.org/10.1056/nejmsa1610524
        • Poon S.J.
        • Greenwood-Ericksen M.B.
        The opioid prescription epidemic and the role of emergency medicine.
        Ann Emerg Med. 2014; 64: 490-495https://doi.org/10.1016/j.annemergmed.2014.06.016
        • Cantrill S.V.
        • Brown M.D.
        • Carlisle R.J.
        • et al.
        Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department.
        Ann Emerg Med. 2012; 60: 499-525https://doi.org/10.1016/j.annemergmed.2012.06.013
        • Lyapustina T.
        • Castillo R.
        • Omaki E.
        • et al.
        The contribution of the emergency department to opioid pain reliever misuse and diversion: a critical review.
        Pain Pract. 2017; 17: 1097-1104https://doi.org/10.1111/papr.12568
        • Butler M.M.
        • Ancona R.M.
        • Beauchamp G.A.
        • et al.
        Emergency department prescription opioids as an initial exposure preceding addiction.
        Ann Emerg Med. 2016; 68: 202-208https://doi.org/10.1016/j.annemergmed.2015.11.033
        • Axeen S.
        • Seabury S.A.
        • Menchine M.
        Emergency department contribution to the prescription opioid epidemic.
        Ann Emerg Med. 2018; 71: 659-667.e3https://doi.org/10.1016/j.annemergmed.2017.12.007
        • Menchine M.D.
        • Axeen S.
        • Plantmason L.
        • Seabury S.
        Strength and dose of opioids prescribed from US emergency departments compared to office practices: implications for emergency department safe-prescribing guidelines.
        Ann Emerg Med. 2014; 64: S1https://doi.org/10.1016/j.annemergmed.2014.07.026
        • Lev R.
        • Lee O.
        • Petro S.
        • et al.
        Who is prescribing controlled medications to patients who die of prescription drug abuse?.
        Am J Emerg Med. 2016; 34: 30-35https://doi.org/10.1016/j.ajem.2015.09.003
        • Pezalla E.J.
        • Rosen D.
        • Erensen J.G.
        • Haddox J.D.
        • Mayne T.J.
        Secular trends in opioid prescribing in the USA.
        J Pain Res. 2017; Volume 10: 383-387https://doi.org/10.2147/jpr.s129553
        • Kuczyńska K.
        • Grzonkowski P.
        • Kacprzak Ł.
        • Zawilska J.
        Abuse of fentanyl: an emerging problem to face.
        Forensic Sci Int. 2018; 289: 207-214https://doi.org/10.1016/j.forsciint.2018.05.042
        • Hoppe J.
        • Kim H.
        • Heard K.
        Association of emergency department opioid initiation with recurrent opioid use.
        Ann Emerg Med. 2015; 65: 493-499.e4https://doi.org/10.1016/j.annemergmed.2014.11.015
        • D'Onofrio G.
        • O'Connor P.G.
        • Pantalon M.V.
        • et al.
        Emergency department–initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.
        JAMA. 2015; 313: 1636-1644https://doi.org/10.1001/jama.2015.3474
        • Phillips D.M.
        JCAHO pain management standards are unveiled.
        JAMA. 2000; 284: 428-429https://doi.org/10.1001/jama.284.4.423b
        • Porter J.
        • Jick H.
        Addiction rare in patients treated with narcotics.
        N Engl J Med. 1980; 302: 123https://doi.org/10.1056/NEJM198001103020221
        • Albrecht E.
        • Taffe P.
        • Yersin B.
        • et al.
        Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.
        Br J Anaesth. 2013; 110: 96-106https://doi.org/10.1093/bja/aes355
        • Fosnocht D.E.
        • Swanson E.R.
        • Barton E.D.
        Changing attitudes about pain and pain control in emergency medicine.
        Emerg Med Clin North Am. 2005; 23: 297-306https://doi.org/10.1016/j.emc.2004.12.003
        • Pines J.M.
        • Perron A.D.
        Oligoanalgesia in ED patients with isolated extremity injury without documented fracture.
        Am J Emerg Med. 2005; 23: 580https://doi.org/10.1016/j.ajem.2004.11.006
        • Lavand'homme P.
        • Estebe J.P.
        Opioid-free anesthesia: a different regard to anesthesia practice.
        Curr Opin Anaesthesiol. 2018; 31: 1-6https://doi.org/10.1097/ACO.0000000000000632