Opioid Prescribing in a Cross Section of US Emergency Departments

Jason A. Hoppe, Lewis S. Nelson, Jeanmarie Perrone, Scott G. Weiner*, Niels K. Rathlev, Leon D. Sanchez, Matthew Babineau, Christopher A. Griggs, Patricia M. Mitchell, Jiemin Ma, Wyatt B. Hoch, Vicken Totten, Matthew S. Salzman, Rupa Karmakar, Janetta L. Iwanicki, Brent W. Morgan, Adam C. Pomerleau, João Delgado, Amanda Medoro, Patrick WhiteleyStephen Offerman, Keith Hemmert, Patrick M. Lank, Josef G. Thundiyil, Andrew Thomas, Sean Chagani, Francesca L. Beaudoin, Franklin D. Friedman, Nathan Cleveland, Krishanthi Jayathilaka, Gail D'Onofrio, Matthew Naftilan, Andrea Koploy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

80 Scopus citations

Abstract

Study objective Opioid pain reliever prescribing at emergency department (ED) discharge has increased in the past decade but specific prescription details are lacking. Previous ED opioid pain reliever prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study is to use a research consortium to analyze the characteristics of patients and opioid prescriptions, using a national sample of ED patients. We also aim to examine the indications for opioid pain reliever prescribing, characteristics of opioids prescribed both in the ED and at discharge, and characteristics of patients who received opioid pain relievers compared with those who did not. Methods This observational, multicenter, retrospective, cohort study assessed opioid pain reliever prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18 to 90 years and discharged with an opioid pain reliever (excluding tramadol) were individually abstracted by standardized chart review by investigators for detailed analysis. Descriptive statistics were generated. Results During the study week, 27,516 patient visits were evaluated in the consortium EDs; 19,321 patients (70.2%) were discharged and 3,284 (11.9% of all patients and 17.0% of discharged patients) received an opioid pain reliever prescription. For patients prescribed an opioid pain reliever, mean age was 41 years (SD 14 years) and 1,694 (51.6%) were women. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with opioid pain reliever prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common opioid pain relievers prescribed were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%). Greater than 99% of pain relievers were immediate release and 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (interquartile range 12 to 20), respectively. Conclusion In a study of ED patients treated during a single week across the country, 17% of discharged patients were prescribed opioid pain relievers. The majority of the prescriptions had small pill counts and almost exclusively immediate-release formulations.

Original languageEnglish (US)
Pages (from-to)253-259.E1
JournalAnnals of Emergency Medicine
Volume66
Issue number3
DOIs
StatePublished - Sep 1 2015

ASJC Scopus subject areas

  • Emergency Medicine

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