12 US Opioid Prescribing Rates of Emergency Physicians, 2012-2017

Abstract

To describe opioid prescribing in the US in the ED setting from 2012 to 2017. Prescription drug abuse has been classified as an epidemic in the US by the Centers for Disease Control and Prevention. Pain is the most common reason adults seek care at emergency departments (ED) and nearly 1 in 5 individuals discharged from the ED receive an opioid prescription. ED patients have also been identified as being at increased risk to abuse opioids if prescribed. There have been several guidelines released to improve opioid prescribing. With such a significant portion of ED patients receiving opioids at discharge, it is important to understand the contribution of EDs to opioid prescriptions and effectiveness of policies designed to reduce the prescription of opioids. Data of all opioids prescribed in the United States from 2012 to 2017 was collected from IQVIA database which provides weighted estimates of opioid prescriptions dispensed in the US. The IQVIA database represents approximately 92% of all retail prescriptions in the US. The data included opioid name, strength, formulation, date of prescription, duration of prescription, amount prescribed and specialty of the prescribing physician. Opioids included in cough and cold medications were excluded. All prescriptions were standardized to morphine milligram equivalents (MME) using the 2018 Centers for Disease Control and Prevention conversion files. Opioid prescriptions were then aggregated by specialty and compared for each year from 2012 to 2017 using t-test. There were a total of 13,502,995 opioid prescriptions prescribed by Emergency physicians in 2012 compared to 7,089,132 opioid prescriptions written by emergency physicians in 2017. The total number of opioids prescribed by emergency physicians decreased each year and from 2012 to 2017 and there was a 44.5% decrease in opioid prescriptions written by emergency physicians from 2012 to 2017 that was statistically significant (p=0.002). When compared to the top 12 opioid prescribing specialties, EM had the greatest reduction in total prescriptions prescribed from 2012 to 2017. When opioid prescriptions were converted to MME, emergency physicians contributed less than 2% of total MME prescribed in the US for each year from 2012 to 2017. Emergency physicians have significantly reduced opioid prescriptions dispensed from 2012 to 2017 and contribute less than 2% to the nation’s supply of prescription opioids.