227 Emergency Physician Opioid Prescriptions That Resulted in Chronic Use

Abstract

There is mounting evidence that the characteristics of a first opioid prescription filled by a patient can portend long-term use. Emergency physicians (EPs) are responsible for only about 5% of all opioid prescriptions but may be the first prescribers for patients with acute pain. The aim of this study was to determine the proportion of ED prescriptions that led to long-term use and the characteristics of those prescriptions. This was a study of the Ohio Prescription Drug Monitoring Program database, which contains a record of all opioid prescriptions filled in the state of Ohio, regardless of payer. Data from 2010-2017 were analyzed. We studied pill forms of the prescribed opioids in the state. We included individuals who had at least one opioid prescription in 2013 but no prescription from 2010-2012, and then followed them through 2017. We first evaluated all first prescriptions and then the subset of those first prescriptions written by emergency physicians. Specialty was available for 59.3% of providers, and we attributed the specialty of “emergency medicine” to a provider if every prescription written by that prescriber in the database during the study period listed EM as their specialty. The primary outcomes were active opioid prescriptions during the follow-up period for 12 and 36 consecutive months with no gap of >30 days. There were 1,205,942 first-time opioid prescriptions written in Ohio in 2013 (representing about 10.4% of the state’s population in that year). Overall, 4,860 (0.40%) initial prescriptions led to chronic use at 1 year and 2,318 (0.19%) led to chronic use at 3 years. Of all first-time prescriptions, 128,347 (10.6%) were confirmed as written by emergency physicians. These prescriptions resulted in 153 (0.12%) chronic users at 1 year and 88 (0.07%) chronic users at 3 years. Features associated with chronic use at 1 year were higher pill count (mean 23.7 (95% CI 20.8-26.5) vs. 17.3 (95% CI 17.3-17.4) pills), higher days’ supply (mean 6.7 (95% CI 5.1-8.2) vs. 3.4 (95% CI 3.4-3.5) days), and higher morphine milligram equivalents per prescription (mean 171.3 (95% CI 127.2-215.4) vs. mean 99.4 (95% CI 98.8-99.9) milligram equivalents). The most common agents first prescribed to the group without long-term use were: hydrocodone (57.4%), oxycodone (20.9%) and tramadol (15.6%). The most common agents first prescribed to those who developed chronic use at 1 year were hydrocodone (43.8%), oxycodone (32.0%), and tramadol (19.6%). Opioid prescriptions written by emergency physicians rarely lead to long-term chronic use at 1 and 3 years. When they do, the prescriptions are more likely to be written for higher pill counts, longer days’ supply and higher morphine milligram equivalents per prescription, and a greater proportion are for oxycodone. When writing for opioids, emergency physicians should use the lowest amount possible to avoid leading to long-term use.