Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006–2010

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...

Full description

Saved in:
Bibliographic Details
Published in:Academic emergency medicine 2016-02, Vol.23 (2), p.159-165
Main Authors: Kea, Bory, Fu, Rochelle, Lowe, Robert A., Sun, Benjamin C., Mycyk, Mark
Format: Article
Language:English
Subjects:
Adult
Age Factors
Analgesics, Opioid - administration & dosage
Analgesics, Opioid - therapeutic use
Drug overdose
Emergency medical care
Emergency Service, Hospital - statistics & numerical data
Female
Health Care Surveys
Humans
Male
Medical diagnosis
Middle Aged
Pain
Pain - drug therapy
Pain Measurement
Patient Discharge - statistics & numerical data
Practice Patterns, Physicians' - statistics & numerical data
Prescription drugs
Severity of Illness Index
Sex Factors
Socioeconomic Factors
Time Factors
United States
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
ISSN:1069-6563
1553-2712
DOI:10.1111/acem.12862