Don’t Blame ERs for Opioid Epidemic

John Commins, September 26, 2017

Prescriptions for commercially insured patients from the ED were 44% less likely to exceed a three-day supply than those written elsewhere. Those patients were also 38% less likely to exceed a daily dose of 50 milligrams of morphine equivalent.

Emergency department prescriptions for opioids are written for shorter duration and smaller doses than those written by other providers, a new study has found.

The Mayo Clinic study in this week’s Annals of Emergency Medicine undermines suggestions that emergency departments are a prime source for opioid abusers, says lead author Molly Jeffery, Ph.D., scientific director, Mayo Clinic Division of Emergency Medicine Research.

“There are a few things that many people assume about opioids, and one is that, in the ED, they give them out like candy,” Jeffery said in remarks accompanying the study. “This idea didn't really fit with the clinical experience of the ED physicians at Mayo Clinic, but there wasn't much information out there to know what's going on nationally.”

The study examined 5.2 million opioid prescriptions written for acute – or new-onset – pain across the nation between 2009 and 2015. None of the patients in the study had received an opioid prescription for the previous six months. This made it easier to compare doses by eliminating patients who built up a tolerance to the drugs.

Prescriptions for commercially insured patients from the ED were 44% less likely to exceed a three-day supply than those written elsewhere. Those patients were also 38% less likely to exceed a daily dose of 50 milligrams of morphine equivalent, which is almost seven pills of five-milligram oxycodone per day. They were 46% less likely to progress to long-term opioid use.

The results were similar for Medicare patients.

An opioid prescribing guideline from the Centers for Disease Control and Prevention issued in 2016 cautions against exceeding a three-day supply or 50 milligrams of morphine equivalent per day for acute pain.

The Mayo researchers said they were surprised to see the high numbers of prescriptions that exceeded 50 milligrams of morphine equivalent per day. One-in-five commercially insured patients in a non-ED setting received a dose exceeding the CDC guideline. People receiving prescriptions exceeding CDC recommendations – regardless of where they were written – were three times more likely to progress to long-term use.

In the last 15 years, the number of Americans receiving an opioid prescription and the number of deaths involving overdoses have roughly quadrupled, according to the CDC. More than 41 people per day died from a prescription opioid overdose in 2015.

On a positive note, the research also found that the proportion of prescriptions progressing to long-term use dropped over the study’s period. 

John Commins

John Commins is a senior editor at HealthLeaders Media.

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