March 17, 2014
Significant Increase In Emergency Room Opioid Prescriptions
April Flowers for redOrbit.com - Your Universe Online
A new study from George Washington University (GW) reports dramatic increases in opioid analgesic prescriptions, such as Percocet, Vicodin, oxycodone and Dilaudid, during emergency room visits in the US from 2001 to 2010. These findings, reported in the journal Academic Emergency Medicine, were not explained by higher visit rates for painful conditions. The visit rates only rose moderately during the study period.
“This trend is especially concerning given dramatic increases in opioid-related overdoses and fatalities in recent years,” said Maryann Mazer-Amirshahi, M.D., adjunct instructor of emergency medicine at the GW School of Medicine and Health Sciences (SMHS). “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.”
The research team found that the percentage of overall emergency department visits where an opioid analgesic was prescribed increased from 20.8 percent to 31 percent during the study period of 2001 to 2010. Prescription rates for some opioids rose dramatically. For example, Dilaudid (one of the most potent and addictive medications) rose to 668.2 percent. The percent of visits for painful conditions, however, only rose 4 percent: from 47.1 percent in 2001 to 51.1 percent in 2010.
“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 Jesse Pines, M.D., director of the Office of Clinical Practice Innovation at GW SMHS. “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.”
The researchers used data from the National Hospital Ambulatory Medical Care Survey to explore which medications, reasons for visiting the emergency room, and demographic groups might explain this change in prescribing rates. Some of the key findings of this ten year study:
- Prescribing rates increased across all age groups, including those over 65 years of age.
- Opioid use increased for both Caucasians and African Americans. However, African Americans were consistently prescribed fewer opioid analgesics than Caucasians.
- In all categories of payer, there were significant increases.
- The Midwest states saw the largest proportional increase. Western states had the highest overall frequency of opioid prescription. The lowest rates of use were found in the Northeast states.
- Urban emergency departments and nonprofit hospitals more commonly prescribed opioids than other institutions.
- All opioid analgesic increased, except codeine and meperidine.
- Hydromorphone (Dilaudid) and morphine saw the highest relative increases overall, from 2005-2010, hydromorphone and oxycodone had the greatest relative increases.