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Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis.
J Med Toxicol. 2015 Sep; 11(3):288-94.JM

Abstract

Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hundred twenty-two visits were associated with chronic pain, and 443 (33 %) visits were associated with an opioid prescription. Providers were 79 % physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol, 2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile range (IQR) 15-30] (range 1-240), morphine equivalents (M.E.) per pill was 7.5 [7.5-7.5] (2.5-120) and total M.E. per prescription was 150 [112.5-270] (15-6000). Physicians were more likely to prescribe a non-opioid than PAs (77 vs 45 %, p < 0.0001). Civilian providers were more likely to prescribe an opioid than active duty providers (58 vs 42 %, p < 0.0001). Providers prescribed a median of 20 pills per prescription and most commonly prescribed oxycodone. PAs were more likely to prescribe an opioid for chronic pain than physicians. Civilian providers were more likely to prescribe an opioid than active duty providers.

Authors+Show Affiliations

Air Force En route Care Research Center, 59th Medical Wing Chief Scientist's Office, San Antonio Military Medical Center, San Antonio, TX, USA, ganemv@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25468314

Citation

Ganem, Victoria J., et al. "Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis." Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, vol. 11, no. 3, 2015, pp. 288-94.
Ganem VJ, Mora AG, Varney SM, et al. Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis. J Med Toxicol. 2015;11(3):288-94.
Ganem, V. J., Mora, A. G., Varney, S. M., & Bebarta, V. S. (2015). Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis. Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, 11(3), 288-94. https://doi.org/10.1007/s13181-014-0449-5
Ganem VJ, et al. Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis. J Med Toxicol. 2015;11(3):288-94. PubMed PMID: 25468314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis. AU - Ganem,Victoria J, AU - Mora,Alejandra G, AU - Varney,Shawn M, AU - Bebarta,Vikhyat S, PY - 2014/12/4/entrez PY - 2014/12/4/pubmed PY - 2016/6/30/medline SP - 288 EP - 94 JF - Journal of medical toxicology : official journal of the American College of Medical Toxicology JO - J Med Toxicol VL - 11 IS - 3 N2 - Chronic pain is a common reason for emergency department (ED) visits. Our objective was to describe opioid prescribing practices of ED providers when treating patients with chronic pain. We retrospectively evaluated opioid prescriptions from EDs at two tertiary care military hospitals. We queried the outpatient record database to obtain a list of opioid medications prescribed and ICD-9 codes associated with visits for chronic pain. We collected provider type and gender, number of pills, opioid type, and refills. We compared the incidence with chi-square or Fisher's exact tests. Wilcoxon test was used for non-parametric continuous variables. Over 3 years, 28,103 visits generated an opioid prescription. One thousand three hundred twenty-two visits were associated with chronic pain, and 443 (33 %) visits were associated with an opioid prescription. Providers were 79 % physicians, 19 % physician assistants (PAs), 81 % male, and 69 % active duty military. Medications were 43 % oxycodone, 30 % hydrocodone, 9.5 % tramadol, 2.5 % codeine, and 15 % other. The number of pills was 20 [interquartile range (IQR) 15-30] (range 1-240), morphine equivalents (M.E.) per pill was 7.5 [7.5-7.5] (2.5-120) and total M.E. per prescription was 150 [112.5-270] (15-6000). Physicians were more likely to prescribe a non-opioid than PAs (77 vs 45 %, p < 0.0001). Civilian providers were more likely to prescribe an opioid than active duty providers (58 vs 42 %, p < 0.0001). Providers prescribed a median of 20 pills per prescription and most commonly prescribed oxycodone. PAs were more likely to prescribe an opioid for chronic pain than physicians. Civilian providers were more likely to prescribe an opioid than active duty providers. SN - 1937-6995 UR - https://www.unboundmedicine.com/medline/citation/25468314/Emergency_Department_Opioid_Prescribing_Practices_for_Chronic_Pain:_a_3_Year_Analysis_ L2 - https://dx.doi.org/10.1007/s13181-014-0449-5 DB - PRIME DP - Unbound Medicine ER -