Opioid Prescription Trends for Migraine in Youth in the ED

Emergency Department
Emergency Department

PHILADELPHIA – The use of opioids in emergency departments (EDs) for the management of migraine pain in adolescents and young adults was found to be common and to be associated with biases, according to study results presented at the 61st Annual Scientific Meeting of the American Headache Society, held July 11 to 14 in Philadelphia, Pennsylvania.

In this study, data from the Cerner Health Facts for the 2010 to 2016 period were examined. Multilevel logistic regression was used to estimate the likelihood of an opioid being prescribed in the ED to treat a primary diagnosis of migraine in a population of adolescents and young adults. The impact of characteristics of patients (eg, age, sex, race, and insurance), encounter (referral source, provider specialty, and encounter duration/year), and ED (region, setting, size, payer mix, and academic status) on the likelihood of being treated with opioids was also examined.

A total of 14,494 unique ED encounters from 180 EDs were identified. Opioids were prescribed within 12 hours of ED admission in 23.1% of all encounters, and these medications were ordered as first-line treatment in 58% of cases.

Participants were found to have a greater likelihood of being prescribed opioids if they were older (adjusted odds ratio [aOR,] 1.08; 95% CI, 1.07-1.10) and if they were seen by a surgical specialist vs an emergency medicine clinician (aOR, 2.29; 95% CI, 1.15 to 4.55). Participants were less likely to receive opioids if they were men (aOR, 0.86; 95% CI, 0.77-0.96), Hispanic (aOR, 0.69; 95% CI, 0.54-0.90), or of a non-white race (aOR, 0.70-0.77; 95% CI, 0.62-0.92).

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Although the percentage of encounters involving opioids varied widely between EDs (mean, 26.4% ± 20.1%; range, 0-100%), encounters involving opioids were found to be more common in EDs visited by higher percentages of commercially insured patients (aOR, 1.97; 95% CI, 1.90-4.30). Encounters involving opioids were less common in EDs in larger hospitals (aOR, 0.86; 95% CI, 0.78 to 0.96).

“These findings may be helpful for benchmarking and informing quality improvement efforts aimed at reducing unwarranted opioid exposure in youth,” noted the researchers.

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Bickel J, Connelly M, Glynn E, Hoffman M. Rates and predictors of using opioids in the emergency department to treat migraine in adolescents and young adults. Abstract presented at: 61st Annual Scientific Meeting of the American Headache Society; July 11-14, 2019; Philadelphia, PA.