Sarasota, FL (WorkersCompensation.com) – Emergency room visits involving opioid prescriptions are one of the risk factors for long-term opioid use. Research has shown that 17 percent of patients who filled their first opioid prescription for a minor painful condition were still using the drugs one year later. But a new study suggests physicians in emergency departments are increasingly turning to alternatives to treat pain.
“The overall percentage of all ED visits by adults at which opioids were prescribed at discharge increased from 19.0% in 2006–2007 to 21.5% in 2010–2011, and decreased to 14.6% in 2016–2017, representing a 30.1% decrease between 2006–2007 and 2016–2017, said the study from the National Health Statistics Report.
The data used for the study was from the 2006-2017 National Hospital Ambulatory Medical Care Survey and included all ED visits by patients aged 18 and over. It involved opioids prescribed at ED discharge, with the results measured in two-year periods
The increased percentage of opioids doled out to ER patients from the 2006-2007 to the 2010-2011 period is not surprising, given this was the time the opioid epidemic was going into full swing. The reduction in opioid prescriptions in EDs from 2010-2011 to the 2016-2017 timeframe corresponds to the decreased rate of opioid prescriptions in the workers’ compensation system, as well as the healthcare system in general. The authors speculate the reasons relate to the concerted efforts to mitigate the overprescribing and misuse of opioids.
“The decreasing trend starting in 2010–2011 may be related to several factors: decreasing volume of prescription opioids; the hundreds of local, state, and federal programs that were implemented with the goal of changing prescribing practices; and prescription drug monitoring programs,” they said.
In addition to the reduction in overall ED opioid prescriptions was a decrease in the percentage of visits with morphine-equivalent and stronger-than-morphine opioids prescribed at discharge. That percentage increased from the 2006-2007 period to 2010-2011, then decreased in the ensuing years. Visits with weaker-than-morphine opioids decreased from 2006-2007 to 2010-2011, then increased from 2012-2013 to the 2016-2017 period.
“The upward trend in the percentage of visits with weaker-than-morphine opioids and corresponding downward trend in the percentage of visits with stronger-than-morphine and morphine-equivalent opioids in recent years may potentially be attributed to changing prescribing practices as a result of guidelines and policies created to monitor and reduce opioid prescribing in the United States,” the authors wrote.
Acetaminophen-hydrocodone remained the most commonly prescribed opioid throughout the study period, although there was a decrease in these prescriptions after the combination medication was rescheduled from a schedule III to a schedule II controlled substance in 2014. Corresponding with that reduction was an increase in tramadol and acetaminophen-codeine. “Tramadol, the second-most prescribed opioid in 2016–2017, is historically known as having a lesser risk of dependence,” the study says, “however, a recent study reported surgical patients receiving tramadol had a higher risk of prolonged use than those receiving other common opioids.”
Reasons for Opioids in EDs
Dental pain was the top diagnosis associated with opioid prescriptions at discharge from EDs. “Patients presenting to the ED complaining of dental pain often report very high levels of pain on numeric rating scales,” according to the report. “Furthermore, EDs generally do not have dental professionals on staff who can treat the underlying cause of the pain, and instead use opioids as the main form of treatment. Recent studies report an increase in ED visits for dental disease, a condition that has been associated with drug-seeking behavior.”
Kidney stones, fractures, back pain and extremity pain were the next highest diagnoses associated with a high percentage of ED visits with opioids prescribed at discharge. The percentage of opioids prescribed for extremity and back pain decreased substantially from 2010-2011 to 2016-2017.
“This decrease may be explained by changing prescribing behaviors of ED providers in response to the opioid epidemic combined with evidence that nonopioid analgesics are just as effective as commonly prescribed opioids in the treatment of acute extremity and back pain,” the authors said.