ED opioid prescriptions linked to lower risk for long-term use
Patients in the ED were more likely to be prescribed opioids in accordance with current CDC guidelines and less likely to progress to long-term use than those prescribed opioids in other clinical settings, according to findings published in Annals of Emergency Medicine.
“Because of a four-fold increase in opioid prescriptions since 1999, long-term opioid use has become major public health issues in the United States,” Molly M. Jeffery, PhD, from the division of emergency medicine research at Mayo Clinic, and colleagues wrote. “Because opioids are frequently prescribed to patients discharged from EDs, it is important to understand the relationship between ED opioid prescribing for opioid-naïve individuals and their risk of progressing to recurrent opioid use.”
Jeffery and colleagues sought to evaluate the risk for long-term use in opioid-naïve patients prescribed opioids in the ED in comparison to other clinical settings. The researchers analyzed administrative claims data of opioid-naïve privately insured and Medicaid Advantage enrollees from Jan. 1, 2009, to Dec. 31, 2015, to compare characteristics of opioid prescriptions attributed to the ED. They also assessed concordance with CDC guidelines and calculated the rate of progression to long-term opioid use.
A total of 5.2 million opioid prescription fills met inclusion criteria. Greater adherence to CDC guidelines for dose, days’ supply and formulation was observed in opioid prescriptions from the ED compared with those from non-ED settings.
Overall, patients who were prescribed opioids in the ED were less likely to progress to long-term use regardless of insurance status. Specifically, when prescribed opioids in the ED, progression to long-term use was 46% less likely in commercial enrollees, 56% less likely in aged Medicare enrollees (65 years or older) and 58% less likely in disabled Medicare enrollees than those prescribed opioids in non-ED settings.
Depending on insurance status, opioid prescriptions exceeding 7 days were 84% to 91% lower in the ED than non-ED settings. Compared with opioid prescriptions from non-ED settings, prescriptions attributed to the ED had a 23% to 37% less likelihood of exceeding 50 mg of morphine equivalents, a 33% to 54% less likelihood of exceeding 90 mg of equivalents and an 86% to 92% less likelihood of being written for long-acting or extended-release formulations.
“Our paper lays to rest the notion that emergency physicians are handing out opioids like candy,” Jeffery said in a press release. “Close adherence to prescribing guidelines may help explain why the progression to long-term opioid use is so much lower in the [emergency room (ER)]. Most opioid prescriptions written in the emergency department are for shorter duration, written for lower daily doses and less likely to be for long-acting formulations.”
“Over time, prescriptions written in the ER for high-dose opioids decreased between 2009 and 2011,” she added. “Less than 5% of opioid prescriptions from the ER exceeded 7 days, which is much lower than the percentage in nonemergency settings. Further research should explore how we can replicate the success of opioid prescribing in emergency departments in other medical settings.” – by Alaina Tedesco
Disclosures: The authors report no relevant financial disclosures.