Opioid Administration, Prescribing in the ED on the Decline in Recent Years

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Data from the National Hospital Ambulatory Medical Care Survey administered between 2005 and 2015 were used for analysis.
Data from the National Hospital Ambulatory Medical Care Survey administered between 2005 and 2015 were used for analysis.

After a rise in the frequency of opioids prescribed in emergency departments (EDs) from 2005 to 2011, a decline was observed from 2012 to 2015, particularly in the 18- to 64-year age group, according to a study published in the Western Journal of Emergency Medicine.

Data from the National Hospital Ambulatory Medical Care Survey administered between 2005 and 2015 were used for analysis. The investigators evaluated ED visits for painful conditions and stratified these visits by age group (18-64, 65-74, 75-84, ≥85 years). Self-reported pain scores were examined, with scores ≥8 indicating severe pain and scores ≤7 indicating nonsevere pain. Trends in opioid use and administration in the ED, as well as opioid prescribing trends in patients ≥65 years, were analyzed.

A total of 21.0 million and 21.7 million ED visits for painful conditions from the National Hospital Ambulatory Medical Care Survey database were examined for the 2005 to 2006 and 2014 to 2015 periods, respectively. No significant changes in opioid prescribing were found in patients aged 65 to 74 and 75 to 84 years between the 2005 to 2006 and the 2014 to 2015 periods. 

A reduction in opioid prescribing to individuals aged 18 to 64 years was found between these 2 periods (absolute decrease, 5.8%; P =.001). In patients ≥65 years, hydromorphone administration increased by 76% between 2005 to 2006 and 2014 to 2015, but insufficient data were available to determine changes in oxycodone, hydrocodone, or codeine administration between these periods.

Limitations of the study include a lack of information on whether patients desired pain medications, the inability to evaluate older patients for cognitive deficits, and the lack of longitudinal data for identifying therapy appropriateness.

The study investigators emphasized that "ED providers need to be aware of increasing rates of opioid abuse and misuse in older adults and should use opioids judiciously."

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Reference

Marra EM, Mazer-Amirshahi M, Mullins P, Pines JM. Opioid administration and prescribing in older adults in U.S. emergency departments (2005-2015). West J Emerg Med. 2018;19(4):678-688.

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