Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006–2010

Abstract

Objective Prescription opioid overdoses are a leading cause of death in the United States. Emergency departments (EDs) are potentially high risk environments for doctor shopping and diversion. We hypothesized that opioid prescribing rates from the ED have increased over time. Methods We analyzed data on ED discharges from the 2006–2010 NHAMCS, a probability sample of all United States EDs. The outcome was documentation of an opioid prescription on discharge. The primary independent predictor was time. Covariates included severity of pain, a pain-related discharge diagnosis, age, gender, race, payer, hospital ownership, and geographic location of hospital. Up to three discharge diagnoses were available in NHAMCS to identify ‘pain-related’ (e.g. back pain, fracture, dental/jaw pain, nephrolithiasis) ED visits. We performed multivariate logistic regression to assess the independent associations between opioid prescribing and predictors. All analyses incorporated NHAMCS survey weights, and all results are presented as national estimates. Results Opioids were prescribed for 18.7% (95% CI: 17.7–19.7%) of all ED discharges, representing 18.8 million prescriptions per year. There were no significant temporal trends in opioid prescribing overall (adjusted p=0.93). Painful discharge diagnoses that received the top 3 highest proportion of opioids prescriptions included: nephrolithiasis (62.1%), neck pain (51.6%), and dental/jaw pain (49.7%). A pain-related discharge diagnosis, non-Hispanic white race, older age, male gender, uninsured status and Western region were associated with opioid prescribing (p<0.05). Conclusions We found with no temporal trend towards increased prescribing from 2006–2012. Our results suggest that problems with opioid over-prescribing are multifactorial and not solely rooted in the ED.

Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use

“…3 Some policymakers and members of the public perceive EDs to be a significant source of overprescription of opioids. 4–6 This perception may stem from the fact that many ED visits involve chronic or acute pain; adult patients reported pain as the primary symptom in 45% of ED visits. 7 With so many patients in pain, it isn’t surprising that recent studies have found that 17-21% of all ED discharges included a prescription for opioids.…”

“…7 With so many patients in pain, it isn’t surprising that recent studies have found that 17-21% of all ED discharges included a prescription for opioids. 4,8 …”

Opioid prescribing and adverse events in opioid-naive patients treated by emergency physicians versus family physicians: a population-based cohort study

“…Emergency department data from the United States indicate that opioid use increased 90% between 2001 and 2010, and that opioids were prescribed at discharge to almost 20% of patients. [10][11][12] Although most emergency physicians likely consider opioid medications safe for the relief of acute pain and may therefore regard their role in the current opioid crisis to be limited to preventing diversion, recent reports suggest that opioids prescribed in the emergency department, especially to opioidnaive patients, are associated with substantial morbidity. [13][14][15] In 2014-2015, there were 4779 hospital admissions due to opioid toxicity in Canada, representing a total of 38 405 days of care provided in Canadian hospitals to patients admitted with a diagnosis of opioid toxicity.…”

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

“…From a community standpoint, prior studies have highlighted the importance of community-based approaches to prevent opioid-related deaths [83], yet none have been explored in the context of GI care. Kea et al have suggested that problems with inappropriate opioid use are multifactorial in nature and not linked with a specific care setting, patient characteristic or provider type [84]. This suggests that interventions grounded in the CCM that actively engage patients, providers, health systems and communities may be especially beneficial.…”