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EDs not major contributor to opioid prescriptions

The number of opioid prescriptions originating from EDs are small and have been declining since 1996, according to research published in Annals of Emergency Medicine.

“Within the medical community, some of the most stringent prescription guidelines aimed at reducing opioid misuse have emerged, targeting ED prescribing,” Sarah Axeen, PhD, from the Keck School of Medicine at the University of Southern California, and colleagues wrote.

“ED-centered policies such as these can only successfully affect the opioid epidemic in the United States if opioid prescribing in EDs significantly contributes to the national drug problem,” they added. “However, the extent to which EDs contribute to the national epidemic of prescription opioid misuse is largely unknown.”

To determine how EDs contribute to national opioid prescribing, Axeen and colleagues performed a retrospective analysis using nationally representative data from the 1996 to 2012 Medical Expenditure Panel Survey. The researchers also estimated opioid prescribing trends by setting, including EDs, office-based sites and inpatient sites, and assessed the likelihood of high-risk patients to receive a disproportionate amount of opioids from EDs.

They excluded patients aged younger than 18 years with diagnosed malignancies. They conducted a multivariable regression analysis to adjust estimates. Opioid prescriptions were measured and standardized by using total milligrams of morphine equivalents.

Data from the survey showed that 47,081 patient-years received at least one opioid prescription. Opioid prescribing in the United States increased 471% from 1996 to 2012. Opioids prescribed from office-based settings were high and increased from 71% in 1996 to 83% in 2012. Conversely, opioids prescribed from the ED were modest and decreased from 7.4% in 1996 to 4.4% in 2012. High-risk opioid users, defined as those in the top 5% of opioid consumption, received only 2.4% of their opioids from EDs, compared with 87.8% of opioid prescriptions being generated by office visits.

On average, participants received 44% of opioid prescriptions from office-based sites, 26% from dental or other outpatient sites, 16% from EDs and 14% from inpatient sites. During the study period, refills of opioid prescriptions from an office-based setting rose 446%, whereas one-time opioid prescriptions rose 277%.

“[EDs] are at the forefront of efforts to reduce harm associated with opioid abuse, but they are not a major source of opioid prescriptions,” Axeen said in a press release. “Policymakers and providers should match interventions with settings where they are most likely to be successful. Efforts to reduce the quantity of opioid prescriptions should focus less on hospital-based prescribing and more on doctor’s office-based prescribing practices, specifically addressing refills or chronic prescriptions.”

“Emergency physicians can best help address our nation’s opioid epidemic by focusing on the development and dissemination of tools that help providers identify high-risk individuals and refer them to treatment,” she added. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.