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Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010.
Acad Emerg Med. 2014 Mar; 21(3):236-43.AE

Abstract

OBJECTIVES

The objective was to describe trends in opioid and nonopioid analgesia prescribing for adults in U.S. emergency departments (EDs) over the past decade.

METHODS

Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2001 through 2010 were analyzed. ED visits for adult patients (≥18 years of age) during which an analgesic was prescribed were included. Trends in the use of six commonly prescribed opioids, stratified by Drug Enforcement Agency (DEA) schedule, as well as nonopioid analgesics were explored, along with the frequency of pain-related ED visits. For 2005 through 2010, data were further divided by whether the opioid was administered in the ED versus prescribed at discharge.

RESULTS

Between 2001 and 2010, the percentage of overall ED visits (pain-related and non-pain-related) where any opioid analgesic was prescribed increased from 20.8% to 31.0%, an absolute increase of 10.2% (95% confidence interval [CI] = 7.0% to 13.4%) and a relative increase of 49.0%. Use of DEA schedule II analgesics increased from 7.6% in 2001 to 14.5% in 2010, an absolute increase of 6.9% (95% CI = 5.2% to 8.5%) and a relative increase of 90.8%. Use of schedule III through V agents increased from 12.6% in 2001 to 15.6% in 2010, an absolute increase of 3.0% (95% CI = 2.0% to 5.7%) and a relative increase of 23.8%. Prescribing of hydrocodone, hydromorphone, morphine, and oxycodone all increased significantly, while codeine and meperidine use declined. Prescribing of nonopioid analgesics was unchanged, 26.2% in 2001 and 27.3% in 2010 (95% CI = -1.0% to 3.4%). Hydromorphone and oxycodone had the greatest increase in ED administration between 2005 and 2010, while oxycodone and hydrocodone had the greatest increases in discharge prescriptions. There was no difference in discharge prescriptions for nonopioid analgesics. The percentage of visits for painful conditions during the period increased from 47.1% in 2001 to 51.1% in 2010, an absolute increase of 4.0% (95% CI = 2.3% to 5.8%).

CONCLUSIONS

There has been a dramatic increase in prescribing of opioid analgesics in U.S. EDs in the past decade, coupled with a modest increase in pain-related complaints. Prescribing of nonopioid analgesics did not significantly change.

Authors+Show Affiliations

The Department of Emergency Medicine, The George Washington University, Washington, DC; The Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24628748

Citation

Mazer-Amirshahi, Maryann, et al. "Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 21, no. 3, 2014, pp. 236-43.
Mazer-Amirshahi M, Mullins PM, Rasooly I, et al. Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010. Acad Emerg Med. 2014;21(3):236-43.
Mazer-Amirshahi, M., Mullins, P. M., Rasooly, I., van den Anker, J., & Pines, J. M. (2014). Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 21(3), 236-43. https://doi.org/10.1111/acem.12328
Mazer-Amirshahi M, et al. Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010. Acad Emerg Med. 2014;21(3):236-43. PubMed PMID: 24628748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010. AU - Mazer-Amirshahi,Maryann, AU - Mullins,Peter M, AU - Rasooly,Irit, AU - van den Anker,John, AU - Pines,Jesse M, PY - 2013/06/13/received PY - 2013/08/20/revised PY - 2013/09/25/revised PY - 2013/10/10/accepted PY - 2014/3/18/entrez PY - 2014/3/19/pubmed PY - 2014/9/30/medline SP - 236 EP - 43 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 21 IS - 3 N2 - OBJECTIVES: The objective was to describe trends in opioid and nonopioid analgesia prescribing for adults in U.S. emergency departments (EDs) over the past decade. METHODS: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2001 through 2010 were analyzed. ED visits for adult patients (≥18 years of age) during which an analgesic was prescribed were included. Trends in the use of six commonly prescribed opioids, stratified by Drug Enforcement Agency (DEA) schedule, as well as nonopioid analgesics were explored, along with the frequency of pain-related ED visits. For 2005 through 2010, data were further divided by whether the opioid was administered in the ED versus prescribed at discharge. RESULTS: Between 2001 and 2010, the percentage of overall ED visits (pain-related and non-pain-related) where any opioid analgesic was prescribed increased from 20.8% to 31.0%, an absolute increase of 10.2% (95% confidence interval [CI] = 7.0% to 13.4%) and a relative increase of 49.0%. Use of DEA schedule II analgesics increased from 7.6% in 2001 to 14.5% in 2010, an absolute increase of 6.9% (95% CI = 5.2% to 8.5%) and a relative increase of 90.8%. Use of schedule III through V agents increased from 12.6% in 2001 to 15.6% in 2010, an absolute increase of 3.0% (95% CI = 2.0% to 5.7%) and a relative increase of 23.8%. Prescribing of hydrocodone, hydromorphone, morphine, and oxycodone all increased significantly, while codeine and meperidine use declined. Prescribing of nonopioid analgesics was unchanged, 26.2% in 2001 and 27.3% in 2010 (95% CI = -1.0% to 3.4%). Hydromorphone and oxycodone had the greatest increase in ED administration between 2005 and 2010, while oxycodone and hydrocodone had the greatest increases in discharge prescriptions. There was no difference in discharge prescriptions for nonopioid analgesics. The percentage of visits for painful conditions during the period increased from 47.1% in 2001 to 51.1% in 2010, an absolute increase of 4.0% (95% CI = 2.3% to 5.8%). CONCLUSIONS: There has been a dramatic increase in prescribing of opioid analgesics in U.S. EDs in the past decade, coupled with a modest increase in pain-related complaints. Prescribing of nonopioid analgesics did not significantly change. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/24628748/Rising_opioid_prescribing_in_adult_U_S__emergency_department_visits:_2001_2010_ L2 - https://doi.org/10.1111/acem.12328 DB - PRIME DP - Unbound Medicine ER -