ED discharge prescriptions for opioid analgesics increased 49% from 2005 to 2010

March 25, 2014, 5:40 pm

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Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010. Mazer-Amirshahi et al. Acad Emerg Med 2014 Mar;21:236-243.

Abstract

The Centers for Disease Control and Prevention has called prescription drug overdose “the fastest growing drug problem in the United States” and an “epidemic.” Most physicians are astounded when first informed about the extent of this problem.

Test your knowledge: How many people died in the United States of prescription drug overdose during the year 2010?

In 2010, approximately 15,000 people died in the United States of prescription drug overdose.

In 2011, how many prescriptions were written for opioid analgesics in the United States?

In 2011, 238 million opioid prescriptions were filled in the U.S., up 37% from 2000.


As we have discussed before, this increase in prescription drug overdose deaths was paralleled by an increase in the number of scripts written for opioid analgesics. It also coincided with an increased emphasis on “pain as the 5th vital sign.’ More liberal dispensing of opioid analgesics were backed by several pain societies and patient advocates groups, many of which were funded in large part by drug manufacturers.

But who was writing all these prescriptions? Were they originating in pain clinics and specialty practices? Primary care offices? Emergency departments?

This retrospective review suggests that emergency departments have contributed their fair share to the accelerated prescription rate. The authors analyzed data from the National Hospital Ambulatory Care Survey (NHAMCS) from 2001 to 2010, looking for opioid use related to emergency department visits. Although the study has many important limitations — including the inability to determine for cases earlier than 2005 whether the opioids were used in the ED or prescribed at discharge — their findings are significant. The key finding is that from 2001 to 2010, the percentage of ED visits in which opioids were prescribed increased from 20.8% to 31.0%.

The authors’ conclusion:

There has been a significant increase in opioid utilization in [ED} visits over the past decade with the most profound rises found in hydromorphone use. Although we cannot directly link ED prescribing with subsequent abuse, this trend requires further investigation given the concomitant rise in prescription opioid abuse and related fatalities. ED providers must be vigilant in addressing pain while minimizing the adverse effects associated with opioid use.

The rate of increase in ED opioid prescriptions may have abated somewhat since 2010, as practitioners have become more aware of the overdose epidemic. Unfortunately, this trend seems to have been accompanied by a spike in the number of deaths related to heroin.

3 Comments:

  1. anonymous Says:

    I’d like to know what effect, if any, the corporatization of EDs, increasing acuity of ED patients, and the focus of hospitals on customer service has had on prescribing trends.

  2. ED Doc Says:

    Shocking. Oh wait, it isn’t. How many times do you see an unsatisfactory score on a Press-Ganey report stating “lack of pain meds” or “only a few days of pain meds given” as the major reason for a poor score?

    You consistently get low scores and what happens? You get fired.

    How do you fix this? Write more pain med scrips.

    We are currently working in a system which rewards doctors for writing those scrips, and threatens their jobs if they don’t. Fix the underlying problem and I strongly suspect that the opiate issue will correct itself.

  3. Leon Says:

    anonymous and ED Doc:

    Great points. The issue of to what extent the introduction of Press-Ganey scores and the emphasis on “customer service” have contributed to the increased prescribing of opiates, especially in emergency departments, is one begging for study.

    My opinion is that the phenomenon has multiple causes, including P-G, pressure from pharmaceutical companies, overwhelming work loads, failure to appreciate the problem, lack of education about opiates, and lack of a systemic approach to the problem (guidelines, restrictions, mechanisms to track prescriptions written and filled, etc.)

    Many of these issues are being approached in certain areas such as Washington State.