The Epidemiologic Association Between Opioid Prescribing, Non-Medical Use, and Emergency Department Visits

Wisniewski, Angela M.; Purdy, Christopher; Blondell, Richard D.

doi:10.1300/j069v27n01_01

Cited by 111 publications

(86 citation statements)

References 15 publications

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“…Median [interquartile range, IQR] daily dose during the episode of long-term use was 4 [3-5] ME for occasional users, 8 [5][6][7][8][9][10][11]] ME for regular users, 17 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] ME for chronic users and 79 [33-197] ME for every-day users.…”

Section: Long-term Opioid Use For Non-cancer Pain In Bcmentioning

confidence: 99%

“…4 Specifically, use of opioids has been found to be associated with bone fractures, road trauma, emergency department visits and both intentional and unintentional toxicity deaths, with a strong dose-response relationship. [5][6][7][8] Trends in total opioid dispensing alone provide limited insights into clinical practice and actual patterns of use by patients. More detailed information is needed about opioid prescribing practices and patterns of opioid use, particularly among long-term users in Canada.…”

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confidence: 99%

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Patterns and trends in long-term opioid use for non-cancer pain in British Columbia, 2005–2012

Smolina

Gladstone

Rutherford

et al. 2016

Can J Public Health

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OBJECTIVES:We aimed to calculate trends in incidence and prevalence rates of long-term opioid use for non-cancer pain, as well as to describe the characteristics of long-term opioid users and their patterns of opioid use. METHODS:We used population-based linked health care and socio-demographic administrative data for British Columbia (BC) between 2005 and 2012. We included individuals who had at least one episode of long-term opioid use during the study period and who were not cancer or palliative care patients.RESULTS: Long-term users comprised only 10% of all individuals prescribed opioids for non-cancer pain, but accounted for 64% of all opioid prescriptions and 87% of all morphine equivalents dispensed in BC during this period. While the incidence rate did not significantly change, the prevalence rate increased by 27% for men and 22% for women. In 2012, there were 3.80 (3.72-3.88) new long-term opioid users per 1,000 men and 4.42 (4.34-4.51) new users per 1,000 women. At the same time, there were 18.3 (95% CI 18.1-18.5) existing long-term users per 1,000 men and 21.7 users (95% CI 21.5-21.9) per 1,000 women. Overall, 2.4% of BC residents were long-term users of prescription opioids in 2012. Most long-term users had one continuous episode of use spanning multiple years. Almost two thirds took opioids every other day or more frequently. CONCLUSION:There is a growing population of long-term opioid users for non-cancer pain in BC, with higher incidence and prevalence rates observed among women than among men.KEY WORDS: Opioid analgesics; chronic pain; incidence; prevalence; inappropriate prescribing La traduction du résumé se trouve à la fin de l'article.

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Section: Long-term Opioid Use For Non-cancer Pain In Bcmentioning

confidence: 99%

mentioning

confidence: 99%

Patterns and trends in long-term opioid use for non-cancer pain in British Columbia, 2005–2012

Smolina

Gladstone

Rutherford

et al. 2016

Can J Public Health

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“…These "drug mentions" provide a representative view of US medication use. 14,16,17 We identified all drug mentions for the drug classes of interest between January 1, 2000, and December 31, 2009, among patients aged $20 years. Using the unique drug codes, we excluded combination medications and nonoral formulations to match the drugs implicated in exposures and poisonings among children.…”

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confidence: 99%

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Medication ingestions are increasing among children despite a number of public health interventions. The majority of these poisonings are related to prescription as opposed to over-the-counter medications. WHAT THIS STUDY ADDS:Rising rates of poisonings in children are strongly correlated with rising use of hypoglycemics, antihyperlipidemics, b-blockers, and opioids among adults. These events are associated with considerable health care utilization, both in terms of emergency department visits and hospital admissions. abstract BACKGROUND AND OBJECTIVES: Nontherapeutic medication ingestions continue to be a major pediatric health problem, with recent increases in ingestions despite a number of public health interventions. It is unknown how changes in adult prescription drug use relate to pediatric medication poisonings. The objective of the study was to measure the association between changing adult prescription drug patterns and pediatric medication exposures and poisonings and identify high-risk classes of medications and pediatric age groups. METHODS:We measured monthly pediatric exposures and poisonings using the National Poison Data System and prescriptions written for adults using the National Ambulatory Medical Care Surveys for 2000 through 2009. Associations between adult prescriptions for oral hypoglycemics, antihyperlipidemics, b-blockers, and opioids and exposures and poisonings among children 0 to 5, 6 to 12, and 13 to 19 years were analyzed by using multiple time-series analysis. Emergency department visits, serious injuries, and hospitalizations stemming from these associations were described.RESULTS: Adult medication prescriptions were statistically significantly associated with exposures and poisonings in children of all ages, with the strongest association observed for opioids. Across medications, the greatest risk was among children 0 to 5 years old, followed by 13-to 19-year-olds. Rates of emergency department visits were highest for events related to hypoglycemics (60.1%) and b-blockers (59.7%), whereas serious injuries and hospitalizations occurred most frequently with opioids (26.8% and 35.2%, respectively) and hypoglycemics (19.5% and 49.4%, respectively). CONCLUSIONS:Increasing adult drug prescriptions are strongly associated with rising pediatric exposures and poisonings, particularly for opioids and among children 0 to 5 years old. These associations have sizable impacts, including high rates of serious injury and health care use. Dr Burghardt contributed to study conception and design, data acquisition, analysis and interpretation of data, drafting, and revising the article; Dr Ayers contributed to data acquisition, analysis and interpretation of data, and revising the article; Dr Brownstein contributed to study conception and design, data acquisition and analysis, and revision; Dr Bronstein contributed to study conception and design and revision; Dr Burns Ewald contributed to study conception and design, data acquisition, and revision; and Dr Bourgeois con...

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“…Many studies look at the effect of patient characteristics on the decision of the medical provider to prescribe pain medications [4,[15][16][17][18][19][20][21][22], but few describe the variability of prescribing habits of ED providers [23][24][25]. The objective of our study was to describe the opioid prescribing practices of physicians and PAs, to include civilian and military providers, in an emergency department when treating patients with a discharge diagnosis of chronic pain.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis

et al. 2014

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Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hundred twenty-two visits were associated with chronic pain, and 443 (33 %) visits were associated with an opioid prescription. Providers were 79 % physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol, 2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile range (IQR) 15-30] (range 1-240), morphine equivalents (M.E.) per pill was 7.5 [7.5-7.5] (2.5-120) and total M.E. per prescription was 150 [112.5-270] (15-6000). Physicians were more likely to prescribe a non-opioid than PAs (77 vs 45 %, p< 0.0001). Civilian providers were more likely to prescribe an opioid than active duty providers (58 vs 42 %, p<0.0001). Providers prescribed a median of 20 pills per prescription and most commonly prescribed oxycodone. PAs were more likely to prescribe an opioid for chronic pain than physicians. Civilian providers were more likely to prescribe an opioid than active duty providers.

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The Epidemiologic Association Between Opioid Prescribing, Non-Medical Use, and Emergency Department Visits

Abstract: The increased number of prescriptions written for hydrocodone and oxycodone between 1995 and 2004 was associated with similar increases in non-medical use and the number of ED visits during this time period.

Cited by 111 publications

References 15 publications

Patterns and trends in long-term opioid use for non-cancer pain in British Columbia, 2005–2012

Patterns and trends in long-term opioid use for non-cancer pain in British Columbia, 2005–2012

Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings

Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis

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