Emergency Department Opioid Prescriptions Dramatically Increase

The portion of emergency department visits that led to an opioid prescription increased almost 50% between 2001 and 2010 while the portion of visits that were for painful conditions barely increased.

The likelihood that an emergency department patient will receive a prescription for an opioid painkiller has increased significantly in recent years, while the portion of visits to emergency departments that are pain-related has only risen moderately, the results of a new study find.

The retrospective study, published in the March 2014 issue of Academic Emergency Medicine, evaluated prescribing trends for opioid and nonopioid painkillers in US emergency departments from 2001 through 2010. Data from emergency department visits in which an analgesic was prescribed for patients aged 18 and older were analyzed from the National Hospital Ambulatory Medical Care Survey. The analysis focused on 6 opioids that are commonly prescribed in the emergency department: hydromorphone, meperidine, morphine, oxycodone, hydrocodone, and codeine. The study also evaluated changes in the frequency of pain-related emergency department visits and assessed the effects of patient demographics, age, and insurance type on prescribing.

The portion of overall visits, whether pain-related or not, in which any opioid was prescribed increased in relative terms by 49% over the study period. In 2001, opioids were prescribed during 20.8% of all visits, increasing to 31.0% in 2010. Prescriptions for opioids categorized as Schedule II controlled substances increased more dramatically—by 90.8% in relative terms, rising from 7.6% of visits in 2001 to 14.5% of visits in 2010. Schedule III through V painkillers were prescribed in 15.6% of all visits in 2010, a 23.8% relative increase from 2001. Prescribing rates for all opioids except codeine and meperidine increased significantly throughout the study period. The greatest relative increases were seen in prescriptions for hydromorphone and morphine, which rose by 668.2% and 330.1%, respectively. Hydrocodone, the most commonly prescribed opioid, was used in 14.0% of all emergency department visits in 2010, up from 10.4% of visits in 2001.

The study’s results indicate that opioid prescribing increased significantly across all age groups and in both black and white patients, although black patients were less likely to receive the painkillers than were white patients throughout the study period. In addition, prescribing trends varied significantly by region. The greatest proportional increase in the rate of opioid prescription occurred in the Midwest, rising from 18.8% to 30.7% of emergency department visits over the study period. Overall, the painkillers were most frequently prescribed in the West, while Northeastern states had the lowest prescription rates.

By contrast with the large increase in opioid prescription rates, prescribing for nonopioid painkillers did not significantly change over the study period. In addition, the results indicate that the portion of visits to emergency departments that were for “painful conditions” increased only slightly, from 47.1% in 2001 to 51.1% in 2010.

The increases in emergency department opioid prescriptions were likely caused by many factors and reflect recent concerns that pain is undertreated, the authors note. Although providers may prescribe opioids with good intentions, the authors are concerned that the painkillers may often be prescribed for conditions for which they are not recommended. They suggest that more research and education and better guidelines are needed to help prescribers.

“Ultimately, a multifaceted approach will likely be required to ensure appropriate use of opioid analgesics in the [emergency department] and to mitigate the morbidity and mortality caused by these medications,” the authors conclude.