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Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010.
Acad Emerg Med. 2016 Feb; 23(2):159-65.AE

Abstract

OBJECTIVES

Prescription opioid overdoses are a leading cause of death in the United States. Emergency departments (EDs) are potentially high-risk environments for doctor shopping and diversion. The hypothesis was that opioid prescribing rates from the ED have increased over time.

METHODS

The authors analyzed data on ED discharges from the 2006 through 2010 NHAMCS, a probability sample of all U.S. EDs. The outcome was documentation of an opioid prescription on discharge. The primary independent predictor was time. Covariates included severity of pain, a pain-related discharge diagnosis, age, sex, race, payer, hospital ownership, and geographic location of hospital. Up to three discharge diagnoses were available in NHAMCS to identify "pain-related" (e.g., back pain, fracture, dental/jaw pain, nephrolithiasis) ED visits. Multivariate logistic regression was performed to assess the independent associations between opioid prescribing and predictors. All analyses incorporated NHAMCS survey weights, and all results are presented as national estimates.

RESULTS

Opioids were prescribed for 18.7% (95% confidence interval = 17.7% to 19.7%) of all ED discharges, representing 18.8 million prescriptions per year. There were no significant temporal trends in opioid prescribing overall (adjusted p = 0.93). Pain-related discharge diagnoses that received the top three highest proportion of opioids prescriptions included nephrolithiasis (62.1%), neck pain (51.6%), and dental/jaw pain (49.7%). A pain-related discharge diagnosis, non-Hispanic white race, older age, male sex, uninsured status, and Western region were positively associated with opioid prescribing (p < 0.05).

CONCLUSIONS

No temporal trend toward increased prescribing from 2006 to 2012 was found. These results suggest that problems with opioid overprescribing are multifactorial and not solely rooted in the ED.

Authors+Show Affiliations

Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR.Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR. Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR.Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26802501

Citation

Kea, Bory, et al. "Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 23, no. 2, 2016, pp. 159-65.
Kea B, Fu R, Lowe RA, et al. Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010. Acad Emerg Med. 2016;23(2):159-65.
Kea, B., Fu, R., Lowe, R. A., & Sun, B. C. (2016). Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 23(2), 159-65. https://doi.org/10.1111/acem.12862
Kea B, et al. Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010. Acad Emerg Med. 2016;23(2):159-65. PubMed PMID: 26802501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010. AU - Kea,Bory, AU - Fu,Rochelle, AU - Lowe,Robert A, AU - Sun,Benjamin C, Y1 - 2016/01/23/ PY - 2015/05/28/received PY - 2015/08/14/revised PY - 2015/08/20/accepted PY - 2016/1/24/entrez PY - 2016/1/24/pubmed PY - 2016/9/15/medline SP - 159 EP - 65 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 23 IS - 2 N2 - OBJECTIVES: Prescription opioid overdoses are a leading cause of death in the United States. Emergency departments (EDs) are potentially high-risk environments for doctor shopping and diversion. The hypothesis was that opioid prescribing rates from the ED have increased over time. METHODS: The authors analyzed data on ED discharges from the 2006 through 2010 NHAMCS, a probability sample of all U.S. EDs. The outcome was documentation of an opioid prescription on discharge. The primary independent predictor was time. Covariates included severity of pain, a pain-related discharge diagnosis, age, sex, race, payer, hospital ownership, and geographic location of hospital. Up to three discharge diagnoses were available in NHAMCS to identify "pain-related" (e.g., back pain, fracture, dental/jaw pain, nephrolithiasis) ED visits. Multivariate logistic regression was performed to assess the independent associations between opioid prescribing and predictors. All analyses incorporated NHAMCS survey weights, and all results are presented as national estimates. RESULTS: Opioids were prescribed for 18.7% (95% confidence interval = 17.7% to 19.7%) of all ED discharges, representing 18.8 million prescriptions per year. There were no significant temporal trends in opioid prescribing overall (adjusted p = 0.93). Pain-related discharge diagnoses that received the top three highest proportion of opioids prescriptions included nephrolithiasis (62.1%), neck pain (51.6%), and dental/jaw pain (49.7%). A pain-related discharge diagnosis, non-Hispanic white race, older age, male sex, uninsured status, and Western region were positively associated with opioid prescribing (p < 0.05). CONCLUSIONS: No temporal trend toward increased prescribing from 2006 to 2012 was found. These results suggest that problems with opioid overprescribing are multifactorial and not solely rooted in the ED. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/26802501/Interpreting_the_National_Hospital_Ambulatory_Medical_Care_Survey:_United_States_Emergency_Department_Opioid_Prescribing_2006_2010_ L2 - https://doi.org/10.1111/acem.12862 DB - PRIME DP - Unbound Medicine ER -