209 Assessing Risk of Opioid Abuse Among the Emergency Medicine Population

Abstract

Prescription opioid abuse is a rapidly growing epidemic in the United States. The American College of Emergency Physicians recommends that prior to prescribing opioids to an individual the provider assess an individual's risk for opioid abuse. Few emergency medicine studies have assessed the use of validated opioid risk assessment tools to assess emergency department patients' risk of misusing opioids. In this study, we assess the feasibility of performing a self-administered validated opioid risk screening tool, the Opioid Risk Tool (ORT), in the waiting room of an emergency department and assessed the risk of opioid abuse among an emergency department (ED) population. The study was conducted over a 3-week period in the waiting room of an academic emergency department with an annual census of approximately 115,000 visits per year. All adults presenting to the emergency department were eligible. Individuals were approached while in the waiting room and chosen randomly based on their seat in the waiting room. The ORT was self-administered via an electronic tablet in the waiting room. The results of the survey were anonymous, and were not shared with clinician providers. A research coordinator was available while the individual completed the survey to assist with completion of the survey if necessary. Any difficulties completing the survey were recorded by the research coordinator. Descriptive statistics were used to analyze the data. A total of 212 individuals were enrolled out of 253 persons invited to participate yielding a response rate of 84%. All completed the survey without difficulty. Males represented 34% of the participants. Overall 40% of the total sample reported a family history of alcohol abuse, 36% reported a family history of illicit drug abuse, and 21% reported a family history of prescription drug misuse. There were no significant differences between the family history of alcohol abuse, illicit drug abuse, or prescription drug misuse between males and females. Males were significantly more likely to report a personal history of ethanol abuse (74% vs 51%) and illicit drug abuse (53% vs 34%). Females were significantly more likely to report a history of depression (44% vs 23%). Seventy-two percent of individuals had a moderate or high opioid risk score. Males had a significantly higher opioid risk score than females (8.9 vs 7.1) and the overall average opioid risk score was 7.69, which is considered moderate opioid risk. Forty-two percent of individuals had a high opioid risk score, which has been associated with a 91% risk of aberrant drug behavior. In our study greater than 70% of the emergency department population was at increased risk of abusing opioids. Future studies should be performed to assess the impact integrating opioid risk scoring tools into clinical practice has on provider prescribing patterns in the emergency department.