Abstract
Opioid prescriptions for treatment of pain in emergency departments (EDs) are associated with long-term opioid use. The temporal pattern of opioid prescribing in the context of the opioid epidemic remains unknown. To examine the temporal pattern of opioid prescribing within an ED for varying pain conditions between 2009 and 2018. A population-based, cross-sectional study was conducted at the ED of an urban academic medical center. All patients treated within that ED between January 1, 2009, and December 31, 2018, were included. The proportion of patients prescribed an opioid for treatment of pain in the ED temporally by condition, condition type, patient demographics, and physician prescriber. Between 2009 and 2018, 556 176 patient encounters took place in the ED, with 70 218 unique opioid prescriptions ordered. A total of 316 632 patients (55.9%) were female, 45 070 (42.6%) were of white race, and 43 412 (40.6%) were privately insured; the median age group was 41 to 45 years. Yearly opioid prescriptions decreased by 66.3% (from 16.3 to 5.5 opioids per 100 encounters) between 2013 and 2018, with a yearly adjusted odds ratio (aOR) of 0.808 (95% CI, 0.802-0.814) compared with the prior year. In patients with musculoskeletal pain (back, joint, limb, and neck pain), opioid prescribing decreased by 71.1% (from 36.7 to 10.6 opioids per 100 encounters between 2013 and 2018; aOR, 0.758; 95% CI, 0.744-0.773). In patients with musculoskeletal trauma (fracture, sprain, contusion, and injury), opioid prescribing decreased by 58.0% (from 34.2 to 14.8 opioids per 100 encounters; aOR, 0.811; 95% CI, 0.797-0.824). In patients with nonmusculoskeletal pain (abdominal pain, kidney stone, respiratory distress, and pharyngitis) opioid prescribing decreased by 53.7% (from 20.1 to 9.3 opioids per 100 encounters; aOR, 0.850; 95% CI, 0.834-0.868). Between 2009 and 2018, patients who were black (aOR, 0.760; 95% CI, 0.741-0.779) and those who were Asian (aOR, 0.714; 95% CI, 0.665-0.764) had the lowest odds of receiving an opioid compared with other racial/ethnic groups. There was a substantial temporal decrease in the number of opioid prescriptions within this ED during the study period. This decrease was associated with substantial relative reductions in opioid prescribing for treatment of musculoskeletal pain compared with fractures and kidney stones.
Highlights
Heightened attention to the prescription of opioids for the treatment of pain has been a central goal in medicine over the past decade
In patients with musculoskeletal pain, opioid prescribing decreased by 71.1%
In patients with nonmusculoskeletal pain opioid prescribing decreased by 53.7%
Summary
Heightened attention to the prescription of opioids for the treatment of pain has been a central goal in medicine over the past decade. The aim of this study was to evaluate temporal changes in overall opioid prescribing and prescriptions for specific pain conditions in an urban academic ED between 2009 and 2018. The temporal pattern of opioid prescribing at the individual clinician level was examined, as previous studies have indicated that the decrease in opioid prescription counts may be dependent on a subset of clinicians decreasing opioid prescribing, while others maintain high-intensity prescribing, regardless of specialty[22] and including ED clinicians.[5,23,24] We examined demographic factors that may be associated with opioid prescribing to assess the possibility of underlying opioid prescription bias within the ED
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