Opioid prescribing for adult emergency room visits is increasing

Harold Mandel's picture
Prescription drugs

There has been an increasing awareness of the dangers of abusing prescribed drugs such as opioids.

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The fears surrounding overdoses of prescribed drugs shocked people worldwide when Michael Jackson suddenly died from a drug overdose given to him by his own personal physician in 2009. The startling loss of such a talented performer at the prime of his life nevertheless has not appeared to cut into the very serious problem of the overprescribing of dangerous drugs. Patients still want the drugs and many physicians are still filling out more and more prescriptions for them.

There has been a rise in opioid prescribing in adult U.S. emergency department visits, reported Academic Emergency Medicine. Researchers set out to describe trends in opioid and nonopioid analgesia prescribing for adults in U.S. emergency departments which have been seen over the past decade. The researchers investigated trends in the use of six commonly prescribed opioids, as stratified by Drug Enforcement Agency (DEA) schedule, and nonopioid analgesics. The researchers also investigated the frequency of pain-related emergency department visits and whether the opioid was administered in the emergency department versus being prescribed at discharge.

It was found that between 2001 and 2010, the percentage of overall emergency department visits which were pain-related and non–pain-related where any opioid analgesic was prescribed increased from 20.8 percent to 31.0 percent, for an absolute increase of 10.2 percent. The use of DEA schedule II analgesics was observed to have increased from 7.6 percent in 2001 to 14.5 percent in 2010, for an absolute increase of 6.9 percent. The use of schedule III through V agents was observed to have increased from 12.6 percent in 2001 to 15.6 percent in 2010, for an absolute increase of 3.0 percent.

Prescribing of many opioids increased significantly, including:

1: Hydrocodone

2: Hydromorphone

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3: Morphine

4: Oxycodone

Prescribing of codeine and meperidine use declined and prescribing of nonopioid analgesics was unchanged. There was an increase in the percentage of visits for painful conditions from 47.1 percent in 2001 to 51.1 percent in 2010, for an absolute increase of 4.0 percent.

It was concluded that there has been a dramatic increase in prescribing of opioid analgesics in U.S. emergency departments in the past decade, along with a modest increase in pain associated complaints. The prescribing of nonopioid analgesics did not change significantly.

Researchers from The George Washington University (GW) found a significant increase in painkillers prescribed to U.S. adults visiting emergency departments, reports GW in a discussion of this research. The dramatic increase in opioid prescriptions during emergency department visits over the last decade was associated with only a modest increase in pain associated complaints. Therefore, these findings could not explained by higher visit rates for painful conditions.

Maryann Mazer-Amirshahi, M.D., co-author of the study, said, “This trend is especially concerning given dramatic increases in opioid-related overdoses and fatalities in recent years.” Amirshahi has gone on to explain that the use of prescription opioids to treat acute painful conditions in emergency departments and hospitals could result in more harm than good, because they can potentially lead to misuse and addiction. Amirshahi suggests that there needs to be more done to monitor opioid prescriptions in emergency departments.

Jesse Pines, M.D., co-author of the study, has commented, “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." Pines explains that even though the intention is to always provide appropriate pain relief, many patients have come to expect opioids. If the patients are in pain and want opioids, but they don’t get them, they may very well report a poor experience.

It has been my impression that the prescription of opioids has been on the rise due to pressure on physicians to meet the expectations of patients. This represents a terribly dangerous trend in view of the potential for catastrophic side effects, including death, which may be associated with opioid drug abuse. Clearly, better guidelines are needed to control the prescribing of opioids in emergency room settings.

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