Opioid Administration and Prescribing in Older Adults in U.S. Emergency Departments (2005-2015)

Abstract

IntroductionWe assess trends in opioid administration and prescribing from 2005–2015 in older adults in United States (U.S.) emergency departments (ED).MethodsWe analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18–64, 65–74, 75–84, ≥ 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ≥ 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored.ResultsOpioid administration in the ED and prescribing at discharge for encounters with patients ≥ 65 years fell overall, but not significantly. By contrast, opioid administration in the ED and prescribing at discharge significantly declined for adult encounters 18–64 by 20% and 32%, respectively. A similar proportion of adult encounters ≥ 65 were administered opioids in the ED as 18–64, but adult encounters ≥ 85 had the lowest rates of administration. A smaller proportion of adult encounters ≥ 65 years with painful conditions were prescribed opioids at discharge compared to <65. However, this age-related disparity in prescribing narrowed over the study period. There were shifts in the specific types of opioids administered and prescribed in adult encounters ≥ 65 years over the study period, with the most notable being a 76% increase in hydromorphone administration comparing 2005–06 to 2014–15.ConclusionFrom 2005–15, 1 in 4 to 1 in 10 ED patients with painful conditions were administered or prescribed an opioid in U.S. EDs. Opioids prescribing increased from 2005–11 and then declined from 2012–15, more so among visits in the 18–64 age group compared to ≥ 65 years. Opioid administrating demonstrated a gradual rise and decline in all adult age groups. Age consistently appears to be an important consideration, where opioid prescribing declines with advancing age. Given the nationwide opioid crisis, ED providers should remain vigilant in limiting opioids, particularly in older adults who are at higher risk for adverse effects.

Does prescribing of immediate release oxycodone by emergency medicine physicians result in persistence of Schedule 8 opioids following discharge?

“…This was the first study in Australia to review the prevalence of S8 prescribing in ED as well as the persistence of S8 opioids following provision of an S8 opioid in ED. The use of IR oxycodone for patients admitted to the ED was also lower than a previous study in the USA (12.1% compared to 19.7%) . The present study identified that the persistence of S8 opioids following an ED admission for patients who were opioid naïve was 5.6%, with only 2.8% of patients prescribed S8 opioids regularly for the long‐term management of non‐cancer pain.…”

“…Escalating opioid use has been associated with an increase in unintentional overdose and death, both internationally and in Australia . Pain is a common aspect of presentations to the ED, with opioids frequently being provided during admission or at discharge . Studies in the USA have indicated that opioids are prescribed at discharge in 8–37% of ED presentations .…”

“…Pain is a common aspect of presentations to the ED, with opioids frequently being provided during admission or at discharge . Studies in the USA have indicated that opioids are prescribed at discharge in 8–37% of ED presentations . Beyond North America there is limited evidence regarding the rates of opioid use in ED.…”

Geographic, Temporal, and Sociodemographic Differences in Opioid Poisoning

“…47 Age has also been associated with different opioid use patterns. 48 States with higher median population age consume more opioids per capita, suggesting that older adults consume more opioids. 49 The different age-specific mapping patterns identified herein may reflect differing community age structures and should guide tailoring interventions to community needs.…”

Substantial Decline in Opioid Prescribing at Emergency Department Visits

“…In contrast, the percentage of visits with weaker than morphine opioids prescribed at discharge decreased from 2006-2007 through 2012-2013 and increased from 2012-2013 through 2016-2017. The upward trend in the percentage of visits with weaker than morphine opioids and corresponding downward trend in the percentage of visits with stronger than morphine and morphine-equivalent opioids in recent years may potentially be attributed to changing prescribing practices as a result of guidelines and policies created to monitor and reduce opioid prescribing in the United States (14,15,18). Oxycodone and hydrocodone have been frequently associated with prescription drug abuse (8).…”