The Development of the Washington State Emergency Department Opioid Prescribing Guidelines

Abstract

The Centers for Disease Control and Prevention (CDC) has classified prescription drug abuse as an epidemic due to the recent dramatic increase in prescription drug overdose deaths. In addition to an increase in overdose deaths involving opioid analgesics, there has also been an increase in substance abuse treatment admissions and an increase in emergency department (ED) visits for nonmedical use of opioid analgesics [1]. According to the Drug Abuse Warning Network, the estimated number of ED visits for nonmedical use of opioid analgesics more than doubled from 2004 to 2008 (from 144,600 to 305,900 visits) [2]. Although quantifying the amount of opioids prescribed from an ED in comparison to other specialties has been a challenge, data from the 2003–2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey suggest that the ED accounts for 39 % of opioid administration or medical record prescription mentions compared with 30.5 % for primary care offices [3]; however, this source does not likely account for the small total amount prescribed from the ED. Analyses of the Vector One National database suggest that ED physicians are among the top five outpatient specialties prescribing opioids to patients 39 years old and younger along with primary care physicians, dentists, and pediatricians [4]. Among individuals who abused prescription opioids upon entering methadone treatment, 13 % reported obtaining their opioids from EDs; [5] Washington State Department of Health (WSDOH) had been concerned regarding data suggesting higher rates of drug overdose deaths and a higher percentage of nonmedical use of prescription pain medication in Washington State compared to the rest of the nation [6]. In 2010, opioid analgesic prescribing per capita in Washington State was significantly higher than the national average—ranking ninth in the nation. In addition, Washington State ranked 14th in the nation in drug overdose deaths in 2008 [1].