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April 9, 2014
ED Prescriptions for Opioids Show Significant Increase in 10-Year Period

Washington, D.C.—The rates of opioid prescribing in emergency departments (EDs) shot up during a recent 10-year period, far exceeding the increase in visit rates for painful conditions, according to recent study from George Washington University.

The study, published in Academic Emergency Medicine, reports significant increases in prescriptions of opioid analgesics during U.S. emergency department visits from 2001 to 2010. The researchers underscore that visit rates for painful conditions increased modestly during the time period.

“This trend is especially concerning given dramatic increases in opioid-related overdoses and fatalities in recent years,” said co-author Maryann Mazer-Amirshahi, MD. “Using prescription opioids to treat acute painful conditions in emergency departments and hospitals might do more harm than good, as they can potentially lead to misuse and addiction. More needs to be done to monitor opioid prescriptions in emergency departments—having recommended standard approaches may be a good starting point.

Between 2001 and 2010, the percentage of overall emergency department visits where an opioid analgesic was prescribed increased from 20.8% to 31%, according to the study. The increase in prescription rates was especially dramatic for some opioid painkillers, including Dilaudid, which went up 668.2%. At the same time, the percentage of visits for painful conditions during the period only increased by 4%, from 47.1% in 2001 to 51.1% in 2010, the authors report.

“Emergency department providers are often caught in a difficult position because some have their pay incentivized based on how patients report their satisfaction with their experience. The intention is always to provide appropriate pain relief, but many patients have come to expect opioids,” said co-author Jesse Pines, MD. “When patients in pain want opioids, but don't get them—which is common—they may report a poor experience. We need to carefully consider how to balance these issues when it comes to national policy, particularly local and national payment policies, in this country.”

To look at ED prescribing trends, researchers analyzed data from the National Hospital Ambulatory Medical Care Survey over the 10-year period. Notable findings include that opioid prescribing increased across all age groups, including those older than 65; that opioid use increased in both blacks and whites, although the drugs were more likely to be prescribed to whites; and that opioid prescriptions increased across all payer types.

The greatest proportional increase in opioid prescriptions was found in Midwestern states, but the highest overall frequency was in the Western states, with the lowest rates of opioid utilization in Northeast states. Opioid prescriptions were more common in urban EDs and nonprofit hospitals nationwide.

Hydromorphone and oxycodone had the greatest relative increases from 2005 to 2010. Among opioid analgesics, only codeine and meperidine showed no increases during the time period, according to the study.





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