206 Predictors of Hydromorphone Administration in US Emergency Departments, 2007-2011

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The past two decades have seen dramatic increases in the administration of opioid analgesics in U.S. EDs, particularly hydromorphone. Hydromorphone is a high-potency semi-synthetic opioid with significant abuse potential. The potential contribution of rising ED hydromorphone administration to prescription opioid abuse and overdose nationally is uncertain but concerning. This study examines recent trends and in and predictors of hydromorphone administration in U.S. EDs. A retrospective review of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2007-2011 was performed. All adult encounters during which an opioid analgesic was administered in the ED were included. Discharge prescriptions were not included. Trends in overall hydromorphone administration and predictors of visits where hydromorphone was administered as compared to visits where other opioids (ie, morphine, oxycodone, etc.) were administered were assessed using logistic regression analysis. An estimated 245.6 million visits were included. Hydromorphone administration increased 24.4%, from 8.2% of visits in 2007 to 10.2% in 2011, p=0.007. Patient characteristics associated with hydromorphone administration compared to other opioids included age <65 years, white race, having private insurance or Medicare, having more than 2 visits in the past year, and a report of severe pain (pain score ≥ 8). Visit characteristics associated with an increased likelihood of hydromorphone administration included ordering of bloodwork, having a procedure performed, and admission to a general medical/surgical unit. Several conditions were associated with higher rates of hydromorphone administration, particularly back pain. Hydromorphone was more likely to be administered in hospitals in the Midwest, west, and south, those in urban areas, and non-teaching hospitals (Table). There was a significant increase in hydromorphone administration in U.S. EDs from 2007-11, with severity of reported pain being the strongest predictor for hydromorphone use. Hydromorphone administration was associated with conditions for which opioid use is controversial, such as back pain and headache as well as for patients with multiple ED visits.