Gender and Prescription Opioid Misuse in the Emergency Department

Choo, Esther K.; Douriez, Carole; Green, Traci

doi:10.1111/acem.12547

Cited by 24 publications

(19 citation statements)

References 20 publications

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“…23,24 Equal numbers of men and women also have ED visits related to prescription opioids. 25 A possible explanation for this discrepancy with our study findings is that women might not identify prescription opioids as drugs being misused based on the ASSIST screening instrument. This observation highlights a gap in knowledge; it is not yet known how current means of detecting substance use differs between sexes.…”

Section: Discussioncontrasting

confidence: 96%

Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention

Beaudoin

Baird

Liu

et al. 2015

Academic Emergency Medicine

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Background Substance use is prevalent among emergency department (ED) patients, and sex has been implicated as an important factor in the etiology, pathophysiology, sequelae, and treatment of substance use disorders. However, additional information is needed about the epidemiology of substance use as it relates to sex among ED patients. Objectives This study examined sex differences in the prevalence and severity of self-reported tobacco, alcohol, and drug use among adult ED patients. Methods A random sample of English- or Spanish-speaking, non–critically ill or injured, 18- to 64-year-old patients was approached at two urban EDs and asked to self-report their lifetime and past 3-month tobacco, alcohol, and drug use. Participants completed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) using an audio computer-assisted self-interview. Participants were categorized by their substance severity (ASSIST score) and need for a brief or more intensive intervention per World Health Organization recommendations. Substance misuse prevalence, frequency, severity, and need for interventions were compared between sexes by substance category. Multivariable logistic regression models were used to examine the association between sexes and the need for intervention after adjusting for sociodemographic characteristics. Results Of the 6,432 participants in the study, the median age was 37 years (interquartile range = 26 to 48 years), and 56.6% were female. Overall, lifetime, and past 3-month use was higher for men across all substances (tobacco, alcohol, and drugs). Among those reporting past 3-month use, the frequency of use was similar between sexes for tobacco and all drugs, but men reported more frequent alcohol use. Men had higher mean ASSIST scores compared to women, 30.3 (standard error [SE] ± 0.8) vs. 21.1 (SE ± 0.5); mean difference 9.2 (95% confidence interval [CI] = 7.4 to 10.9). The need for any intervention (brief or intensive) was similar between sexes for tobacco and drugs. After sociodemographic factors were adjusted for, women were less likely than men to need any intervention for alcohol (odds ratio [OR] = 0.6; 95% CI = 0.4 to 0.8), but not other substances: tobacco (OR = 0.9; 95% CI = 0.6 to 1.3), marijuana (OR = 0.8; 95% CI = 0.6 to 1.1), or other drugs (OR = 1.1; 95% CI = 0.7 to 1.7). Conclusions Although men have a higher overall prevalence of substance use, the frequency and severity of use were similar for men and women for most substances. After other characteristics were adjusted for, sex appears associated with the need for interventions for alcohol, but not tobacco, marijuana, or other drugs.

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Section: Discussioncontrasting

confidence: 96%

Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention

Beaudoin

Baird

Liu

et al. 2015

Academic Emergency Medicine

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show abstract

“…Moreover, as gender has been pointed out as a relevant factor in prescription opioid‐use disorder (Choo, Douriez & Green, ; Cochran et al., ; Han, Kass, Wilsey & Li, ; Kaye et al., ; Kerridge et al., ), measurement invariance was tested to assess if the ARSW was sensitive to gender characteristics. No reduction in the goodness of fit of the model was observed as restrictions were incorporated, reaching the highest level of invariance with appropriate fit indices (CFI = 0.88 and RMSEA = 0.04).…”

Section: Discussionsupporting

confidence: 64%

The Adjective Rating Scale for Withdrawal: Validation of its ability to assess severity of prescription opioid misuse

Coloma-Carmona

Carballo

Marín

et al. 2018

European Journal of Pain

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“…Prior studies have assessed if patient characteristics, such as gender, age, insurance type, and socioeconomic status are significant predictors of quality of pain management, opioid prescribing, and drug non-medical use [ 7 , 8 ]. Our results show that the Indiana rules are indeed differently associated to different patient subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…However, little is known about how the emergency rules differentially impact patient subgroups. Prior research has identified patient characteristics, such as gender, age, insurance type, and socioeconomic status as significant predictors of pain management, opioid prescribing, and drug non-medical use [ 7 , 8 ]. In addition, research has documented issues attributed to biases in prescribing, such as: 1) undertreating pain in some patient subgroups, thus worsening an existing disparity in pain management [ 7 , 8 ], and 2) failing to correct overprescribing for other patient groups, thus exposing them to the harmful effects of opioid use and non-medical use [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

The effects of state rules on opioid prescribing in Indiana

Achkar

Grannis

Revere

et al. 2018

BMC Health Serv Res

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BackgroundPrescription opioids have been linked to over half of the 28,000 opioid overdose deaths in 2014. High rates of prescription opioid non-medical use have continued despite nearly all states implementing large-scale prescription drug monitoring programs (PDMP), which points to the need to examine the impact of state PDMP’s on curbing inappropriate opioid prescribing. In the short-term, PDMPs have been associated with short-term prescribing declines. Yet little is known about how such policies differentially impact patient subgroups or are interpreted by prescribing providers. Our objective was to compare volumes of prescribed opioids before and after Indiana implemented opioid prescribing emergency rules and stratify the changes in opioid prescribing by patient and provider subgroups.MethodsAn interrupted time series analysis was conducted using data obtained from the Indiana PDMP. Prescription level data was merged with census data to characterize patient socioeconomic status. Analyses were stratified by patients’ gender, age, opioid dosage, and payer. The primary outcome indicator was the total morphine equivalent dose (MED) of dispensed opioids per day in the state of Indiana. Also considered were number of unique patients, unique providers, and prescriptions; MED per transaction and per day; and number of days supplied.ResultsAfter controlling for time trends, we found that total MED for opioids decreased after implementing the new emergency rules, differing by patient gender, age, and payer. The effect was larger for males than females and almost 10 times larger for 0–20 year olds as compared to the 60+ age range. Medicare and Medicaid patients experienced more decline in prescribing than patients with private insurance. Patients with prescriptions paid for by workers’ comp experienced the most significant decline. The emergency rules were associated with decline in both the number of prescribers and the number of day supply.ConclusionsAlthough the Indiana opioid prescribing emergency rules impacted statewide prescribing behavior across all individual patient and provider characteristics, the emergency rules’ effect was not consistent across patient characteristics. Further studies are needed to assess how individual patient characteristics influence the interpretation and application of state policies on opioid prescribing.

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Gender and Prescription Opioid Misuse in the Emergency Department

Cited by 24 publications

References 20 publications

Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention

Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention

The Adjective Rating Scale for Withdrawal: Validation of its ability to assess severity of prescription opioid misuse

The effects of state rules on opioid prescribing in Indiana

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