High Variability of Opioid Prescribing Within and Across Emergency Departments in the US Veterans Health Administration

Evaluation of Interventions to Reduce Opioid Prescribing for Patients Discharged From the Emergency Department

“…Forty-five of 63 studies could be included in the meta-analysis for 1 or both components of our main outcome: 36 (80%) studies for the prescription rate 11 , 26 , 27 , 28 , 29 , 30 , 31 , 35 , 53 , 54 , 55 , 56 , 57 , 58 , 62 , 63 , 64 , 65 , 66 , 70 , 71 , 72 , 73 , 74 , 78 , 81 , 83 , 85 , 86 , 87 , 88 , 89 , 90 , 100 , 102 , 103 and 23 (51%) for the prescribed opioid quantity 11 , 26 , 29 , 30 , 35 , 36 , 38 , 39 , 54 , 56 , 63 , 64 , 70 , 71 , 81 , 83 , 84 , 85 , 94 , 95 , 96 , 97 , 98 ...…”

“…Forty-five of 63 studies could be included in the meta-analysis for 1 or both components of our main outcome: 36 (80%) studies for the prescription rate and 23 (51%) for the prescribed opioid quantity at ED discharge. The interventions were associated with a significant reduction in the opioid prescription rate in both ITS (6-month step change, −22.61% [95% CI, −30.70% to −14.52%]; I 2 = 77%) (Figure 2) and other study designs (OR, 0.56 [95% CI, 0.45 to 0.70]; I 2 = 99%) (eFigure 4 in the Supplement).…”

“… 5 Although a decrease in opioid prescribing has been observed in recent years from emergency department (ED) physicians, 6 , 7 , 8 it can still be optimized because variability in opioid prescribing among ED physicians remains substantial, and overprescribing continues to be frequent. 9 , 10 , 11 , 12 , 13 Opioid prescription to patients with acute pain after an ED visit can lead to long-term use 14 , 15 and opioid use disorders. 16 Furthermore, it has been shown that as much as 68% of the initial opioid prescription after an ED visit for acute pain is left unused.…”

“…Despite this ongoing crisis, opioids are still frequently prescribed for home pain management by physicians because some patients may need them for pain control when alternatives are not sufficient . Although a decrease in opioid prescribing has been observed in recent years from emergency department (ED) physicians, it can still be optimized because variability in opioid prescribing among ED physicians remains substantial, and overprescribing continues to be frequent . Opioid prescription to patients with acute pain after an ED visit can lead to long-term use and opioid use disorders .…”

“…11,[26][27][28][29][30][31]35,[53][54][55][56][57][58][62][63][64][65][66][70][71][72][73][74]78,81,83,[85][86][87][88][89][90]100,102,103 and 23 (51%) for the prescribed opioid quantity11,26,29,30,35,36,38,39,54,56,63,64,70,71,81,[83][84]…”