Abstract
Addiction associated with prescription opioids is increasing worldwide, including Switzerland. We aimed (1) to determine whether the prevalence and incidence of opioid therapy at an emergency department (ED) in Switzerland has changed over five years and (2) to characterise consultations with incident opioid prescription. In this retrospective chart review, pre-existing opioid treatment and new prescriptions at the ED of Bern University Hospital “Inselspital”, Switzerland, between 2013 and 2017 were identified from the ED documentation system. Patients already taking opioids before presentation (prevalent opioid use) were distinguished from opioid-naïve patients who were prescribed opioids for the first time (incident opioid prescription) and relative numbers in every half year from 2013 to 2017 were calculated. Demographic and consultation characteristics were analysed to determine factors associated with incident opioid prescription. Within the observation period, 199,299 patients consulted the ED. Of those, 4.95% (95% confidence interval [CI] 4.86–5.05, n = 9868) were using opioids on admission. Nearly 7.07% of them (95% CI 6.57–7.58, n = 698), 0.35% of the complete sample, were prescribed additional opioids. Incident opioid prescription for opioid-naïve patients was found in 2.26% of patients (95% 2.19–2.32, n = 4499). The relative number of prevalent opioid users did not show a significant (p = 0.163) association with time (categorised in half years) when adjusted for the potential confounders age group, trauma, the interaction of trauma and age group, other chief complaint, type of admission and time of admission. Incident opioid prescriptions significantly decreased over the study period (slope = −0.041% per half year, standard error = 0.012%, p = 0.007). The trend persisted after adjustment for the abovementioned potential confounders. Consultations resulting in opioid prescription were significantly associated with older age, musculoskeletal disorders and trauma (p <0.05). Opioid prescriptions in a Swiss ED decreased between 2013 and 2017. Although this might be a sign of awareness of the risks of opioid prescription, the conclusion is derived from a single centre study and the observed trend warrants confirmation by data from other sources.
Highlights
Pain is the most common motive for seeking medical care, accounting for over half of the chief complaints in emergency departments (EDs) [1]
Incident opioid prescriptions significantly decreased over the study period
Opioid prescriptions in a Swiss ED decreased between 2013 and 2017. This might be a sign of awareness of the risks of opioid prescription, the conclusion is derived from a single centre study and the observed trend warrants confirmation by data from other sources
Summary
Pain is the most common motive for seeking medical care, accounting for over half of the chief complaints in emergency departments (EDs) [1]. Opioid use disorders are estimated to have increased worldwide by 50% between 1990 and 2016 [2]. In the USA, opioid addiction has reached epidemic proportions, with 18,238 opioid-related deaths; in 2016, opioids were the fifth leading cause of death in men aged between 15 and 49 years [2, 3]. Patients discharged from the ED after an opioid overdose show increased mortality, in the following 2 days [4]. In 2015, 36.4% of the population above 12 years in the USA used opioids and it was estimated that addiction associated with prescription opioids concerned 0.7% [5, 6]. The same percentage (0.7%) of the global population aged 15–64 years was assessed as misusing prescription drugs in 2016 [7]
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