Incidence of opioid use disorder in the year after discharge from an emergency department encounter

Punches, Brittany E.; Ancona, Rachel M.; Freiermuth, Caroline E.; Brown, Jennifer L.; Lyons, Michael S.

doi:10.1002/emp2.12476

Cited by 5 publications

(7 citation statements)

References 31 publications

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“…Our prevalence is higher than most national studies in EDs, ranging from 6.5 to 9%. [22][23][24][25] Although we were able to benefit from the application of two screening methods, these findings should be of concern nationally as unidentified opioid and other substance use may be much higher than anticipated.…”

Section: Discussionmentioning

confidence: 81%

Screening for problematic opioid use in the emergency department: Comparison of two screening measures

Punches,

Freiermuth,

Sprague

et al. 2024

JACEP Open

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Study objectiveEarlier intervention for opioid use disorder (OUD) may reduce long‐term health implications. Emergency departments (EDs) in the United States treat millions with OUD annually who may not seek care elsewhere. Our objectives were (1) to compare two screening measures for OUD characterization in the ED and (2) to determine the proportion of ED patients screening positive for OUD and those who endorse other substance use to guide future screening programs.MethodsA cross‐sectional study of randomly selected adult patients presenting to three Midwestern US EDs were enrolled, with duplicate patients excluded. Surveys were administered via research assistant and documented on tablet devices. Demographics were self‐reported, and OUD positivity was assessed by the DSM 5 checklist and the WHO ASSIST 3.1. The primary outcome was the concordance between two screening measures for OUD. Our secondary outcome was the proportion of ED patients meeting OUD criteria and endorsed co‐occurring substance use disorder (SUD) criteria.ResultsWe enrolled 1305 participants; median age of participants was 46 years (range 18–84), with 639 (49.0%) Non‐Hispanic, White, and 693 (53.1%) female. Current OUD positivity was identified in 17% (222 out of 1305) of the participants via either DSM‐5 (two or more criteria) or ASSIST (score of 4 or greater). We found moderate agreement between the measures (kappa = 0.56; Phi coefficient = 0.57). Of individuals screening positive for OUD, 182 (82%) endorsed criteria for co‐occurring SUD.ConclusionsOUD is remarkably prevalent in ED populations, with one in six ED patients screening positive. We found a high prevalence of persons identified with OUD and co‐occurring SUD, with moderate agreement between measures. Developing and implementing clinically feasible OUD screening in the ED is essential to enable intervention.

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Section: Discussionmentioning

confidence: 81%

Screening for problematic opioid use in the emergency department: Comparison of two screening measures

Punches,

Freiermuth,

Sprague

et al. 2024

JACEP Open

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“…First , we found that the increased risk for OUD association with an OP in the Swedish population was large, with a raw HR of 7.10 which was reduced to 5.86 with standard covariates. This is a much larger increased risk than recently seen in one-year follow-up of nearly 50 000 patients who received an OP as part of an ER visit (HR, 1.1; 95% CI 0.9–1.4) (Punches, Ancona, Freiermuth, Brown, & Lyons, 2021 ), and more modest than the nearly 15-fold increased risk (5.8 v. 0.4%) risk of an ‘opioid-abuse related diagnosis’ in a one year follow-up of a sample of over 750 000 adolescents and young adults from the Optum Research Database receiving a first time OP during a dental visit (Schroeder, Dehghan, Newman, Bentley, & Park, 2019 ). The magnitude of the OP-OUD association found in the Swedish general population highlights the public health importance of the risk for iatrogenic OUD.…”

Section: Discussionmentioning

confidence: 90%

Risk factors for the development of opioid use disorder after first opioid prescription: a Swedish national study

et al. 2022

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Background We need to better understand the frequency and predictors of opioid use disorder (OUD) after first opioid prescription (OP). Methods We followed 1 516 392 individuals from the Swedish population born 1980–2000, from 1 July 2007, until 31 Dec 2017. We examined putative risk predictors with univariable and multivariable Cox Models and the potential causal effects of predictors by propensity score and co-sibling analyses. Result Of the individuals in our cohort, 24.8% (375 404) received a first OP, of whom 3034 (0.90%) developed a subsequent first OUD. The hazard ratio (HR) (± 95% CIs) for OUD after OP equaled 7.10 (6.75–7.46), with a mean time to onset of 3.41 (2.39) years. The strongest putative risk factors for development of OUD after OP were prior psychiatric and substance use disorders, criminal behavior, parental divorce/death, poor school performance, current community deprivation, divorce, and male sex. Few predictors differed across sexes. OP renewal was associated with a HR of 3.66 (3.41–3.93) for OUD. Co-sibling and propensity score analyses suggested that at least a moderate proportion of the risk factor-OUD association was likely causal. A risk score to predict OUD after OP had an AUC of 0.85, where nearly 60% of cases scoring in the top decile. Conclusions In a general population sample, an OP represents a substantial risk factor for subsequent OUD. Many of the risk factors for OUD after OP can be readily assessed at the time of potential OP, permitting clinicians to evaluate the risk of iatrogenic OUD.

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“…We first conducted univariable analyses to quantify the association between at-risk opioid use and ED opioid exposure (none, ED prescription only, ED administration for analgesia only, ED administration and prescription), as well as a wide array of potential confounders of this association and possible risk factors for at-risk opioid use leveraging literature and expert opinion [29,40,41]. We then used multivariable logistic regression to further characterize the relationship between ED opioid exposure and at-risk opioid use, accounting for potential confounders and risk factors.…”

Section: Primary Data Analysismentioning

confidence: 99%

Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study

et al. 2022

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Objective Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. Methods Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. Results Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). Conclusions ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.

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Incidence of opioid use disorder in the year after discharge from an emergency department encounter

Cited by 5 publications

References 31 publications

Screening for problematic opioid use in the emergency department: Comparison of two screening measures

Screening for problematic opioid use in the emergency department: Comparison of two screening measures

Risk factors for the development of opioid use disorder after first opioid prescription: a Swedish national study

Predicting at-risk opioid use three months after ed visit for trauma: Results from the AURORA study

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