Grounding Frequent Flyers, Not Abandoning Them: Drug Seekers in the ED

Millard, William B.

doi:10.1016/j.annemergmed.2007.02.013

Cited by 18 publications

(11 citation statements)

References 17 publications

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“…15 However, emergency medicine practitioners have reported that they are frequently targeted by patients seeking opioid analgesic prescriptions for nonmedical use. 16,18,19 This problem has prompted ED guidelines for opioid prescription practices recently promulgated by the American College of Emergency Physicians as well as the States of Washington and Ohio and the City of New York. 27,[40][41][42] We found that ED opioid-related service patterns and ED opioid prescribing practices among most enrollees and their providers did not meet the selected criteria for any of the indicators of suboptimal care; 90% of prescription practices were deemed appropriate by our criteria.…”

Section: Discussionmentioning

confidence: 99%

“…17 Some patients engage in doctor shopping-a practice where multiple prescriptions for controlled substances are gathered from multiple providers-to obtain large quantities of medication. 18 In one state, 88% of emergency medicine physicians reported seeing such patients at least once a week. 19 Therefore, opioids prescribed incautiously in EDs might play a role in prescription opioid misuse and overdose fatality.…”

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confidence: 99%

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Opioid Prescribing in Emergency Departments

et al. 2013

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Objective: Emergency departments (EDs) routinely provide care for patients seeking treatment for painful conditions; however, they are also targeted by people seeking opioid analgesics for nonmedical use. This study determined the prevalence of indicators of potential ED opioid misuse and inappropriate prescription practices by ED providers in a large, commercially insured, adult population. Research Design and Indicators:We analyzed the 2009 Truven Health MarketScan s Research Databases to examine the ED visits of enrollees aged 18-64 years. Indicators used to mark potential inappropriate use included opioid prescriptions overlapping by one week or more; overlapping opioid and benzodiazepine prescriptions; high daily doses (Z100 morphine milligram equivalents); long-acting/extended-release (LA/ER) opioids for acute pain, and overlapping LA/ER opioids. Analyses were stratified by sex. Results:We identified 400,288 enrollees who received at least one ED opioid prescription. At least one indicator applied to 10.3% of enrollees: 7.7% had high daily doses; 2.0% had opioid overlap; 1.0% had opioid-benzodiazepine overlap. Among LA/ER opioid prescriptions, 21.7% were for acute pain, and 14.6% were overlapping. Females were more likely to have at least one indicator. Conclusions:In some instances, the prescribing of opioid analgesics in EDs might not be optimal in terms of minimizing the risk of their misuse. Guidelines for the cautious use of opioid analgesics in EDs and timely data from prescription drug monitoring programs could help EDs treat patients with pain while reducing the risk of nonmedical use.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Opioid Prescribing in Emergency Departments

et al. 2013

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“…The characteristic behavior of drug user patients, with repetitive and insistent requests and manifestations of anxiety and irritability may also influence the decision to give or not the analgesic 'if necessary' (5,18,20) , since such behavior is difficult to manage.…”

Section: Discussionmentioning

confidence: 99%

Opioid analgesic administration in patients with suspected drug use

Kreling

Pimenta

2017

Rev. Bras. Enferm.

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Objective: To identify the prevalence of patients suspected of drug use according to the nursing professionals' judgement, and compare the behavior of these professionals in opioid administration when there is or there is no suspicion that patient is a drug user. Method: A cross-sectional study with 507 patients and 199 nursing professionals responsible for administering drugs to these patients. The Chi-Square test, Fisher's Exact and a signifi cance level of 5% were used for the analyzes. Results: The prevalence of suspected patients was 6.7%. The prevalence ratio of administration of opioid analgesics 'if necessary' is twice higher among patients suspected of drug use compared to patients not suspected of drug use (p = 0.037). Conclusion: The prevalence of patients suspected of drug use was similar to that of studies performed in emergency departments. Patients suspected of drug use receive more opioids than patients not suspected of drug use. Descriptors: Opioid Analgesics; Drug Abuse; Nursing; Pain; Patients. RESUMO Objetivo: Identifi car a prevalência de pacientes com suspeita de uso de drogas conforme opinião de profi ssionais de enfermagem e comparar a conduta desses profi ssionais na administração de opioides quando há ou não suspeita de que o paciente seja usuário de drogas. Método: Estudo transversal com 507 pacientes e 199 profi ssionais de enfermagem responsáveis pela administração de medicamentos a esses pacientes. Para as análises foram utilizados os testes de Qui-Quadrado, Exato de Fisher e um nível de signifi cância de 5%. Resultados: A prevalência de pacientes suspeitos foi 6,7%. A razão de prevalência de administração de analgésicos opioides "se necessário" é duas vezes maior entre os pacientes suspeitos em relação aos não suspeitos (p=0,037). Conclusão: A prevalência de suspeitos foi semelhante à de estudos realizados em departamentos de emergência. Os suspeitos de serem usuários de drogas recebem mais opioides do que os não suspeitos. Descritores: Analgésico Opióide; Abuso de Drogas; Enfermagem; Dor; Pacientes. RESUMEN Objetivo: Identifi car la prevalencia de pacientes con sospecha de uso de drogas de acuerdo con la opinión de los profesionales de enfermería y comparar el comportamiento de estos profesionales en la administración de opioides cuando hay o no hay sospecha de que el paciente sea un consumidor de drogas. Método: Estudio transversal con 507 pacientes y 199 enfermeras responsables de la administración de medicamentos a estos pacientes. Para el análisis se utilizó la prueba de Chi-cuadrado, la prueba exacta de Fisher y un nivel de signifi cación del 5%. Resultados: La prevalencia de pacientes con sospecha de uso de drogas fue del 6,7%. La razón de prevalencia de la administración de analgésicos opioides 'si es necesario' es dos veces mayor entre los pacientes con sospecha de uso de drogas en comparación a las personas sin sospecha de uso de drogas (p = 0,037). Conclusión: La prevalencia de los sospechosos fue similar a los estudios llevados a cabo en los servicios de urgenc...

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“…Patients who frequent the ED are more likely to have complex problems, be socially and economically disadvantaged, covered by Medicaid or Medicare, have comorbid psychiatric and substance abuse conditions, be in overall poor health, and have made frequent outpatient clinic visits. 8,9 Some ED visitors go to multiple EDs in their communities to obtain prescriptions for drugs prone to abuse, a behavior known as “drug seeking.” 10 Many efforts, such as statewide prescription monitoring programs (PDMP), patient alert lists, and a non-narcotic protocol in the ED, have been implemented with unclear effect on ED opioid prescribing practices. 11–13 …”

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confidence: 99%

A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits

Neven

Paulozzi

Howell

et al. 2016

The Journal of Emergency Medicine

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Background Increasing prescription overdose deaths have demonstrated the need for safer ED prescribing practices for patients who are frequent ED users. Objectives We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. Methods We conducted a multi-site randomized controlled trial (RCT) across all EDs in a metropolitan area. 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. Results The intervention arm experienced a 34% decrease (IRR = 0.66, p < 0.001; 95% CI: 0.57 – 0.78) in ED visits and an 80% decrease (OR = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers. Conclusion This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing.

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Grounding Frequent Flyers, Not Abandoning Them: Drug Seekers in the ED

Cited by 18 publications

References 17 publications

Opioid Prescribing in Emergency Departments

Opioid Prescribing in Emergency Departments

Opioid analgesic administration in patients with suspected drug use

A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits

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