Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

Abstract

BACKGROUND Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown. METHODS We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics. RESULTS Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses. CONCLUSIONS Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.)

Addressing the Opioid Epidemic: Is There a Role for Physician Education?

“…While prescription drug monitoring programs (PDMPs)-prescription databases that allow physicians to check for signs of opioid abuse before prescribing-have little effect on average (Paulozzi et al, 2011;Reifler et al, 2012;Haegerich et al, 2014;Meara et al, 2016), research shows that they are more effective when states require physicians to consult them (Dowell et al, 2016;Buchmueller and Carey, 2017;Dave et al, 2017). Furthermore, among patients treated in the same emergency room, Barnett et al (2017) demonstrate that those who happen to be treated by a physician with a higher propensity to prescribe opioids are more likely to be dependent on opioids 12 months later. Despite being the gatekeepers of the legal opioid supply, very little is known about why some physicians are more likely to prescribe opioids than others 1 or about what role physician training can play in bringing the epidemic under control.…”

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

“…[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. 16 Patients admitted for opioid toxicity remained in hospital for an average of 8.0 days, longer than the stay for those admitted for a heart attack, pneumonia or hip replacement surgery.…”

Opioid Crisis

“…This suggests that receiving an opioid for even one encounter could increase future long-term opioid abuse and potentially increase adverse outcomes among elderly people. It is not known whether over-prescribing by some practitioners is amenable to intervention [22].…”