Opioid prescriptions to opioid-naive patients in the emergency department (ED) setting were shown to be more in line with the Centers for Disease Control and Prevention (CDC) recommendations and less likely to lead to long-term opioid use compared with non-ED prescriptions, according to the results of a recent study published in the Annals of Emergency Medicine.

To determine the characteristics of opioid prescriptions in the ED, researchers analyzed, using an administrative claims database, 5.2 million opioid prescription fills from opioid-naive patients who had not been prescribed opioids in the preceding 6 months, and who had no hospice claims or cancer diagnosis. Agreement with CDC guidelines and progression to long-term opioid use were compared between ED and non-ED settings.

Opioid prescriptions from the ED were more likely to adhere to CDC guidelines compared with those from other settings, based on dose, daily supply, and formulation. Compared with other settings, prescriptions from the ED were 44% to 52% more likely to provide <3 days’ supply and 84% to 91% more likely to provide <7 days’ supply. Similarly, ED prescriptions were 33% to 54% less likely to be >90 mg of morphine equivalent and were 86% to 92% less likely to be for long-acting or extended-release formulas.

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Importantly, those with prescriptions from outside the ED were more likely to progress to long-term opioid use in commercially insured patients (adjusted risk ratio [aRR], 0.54), elderly Medicare patients (aRR 0.44), and disabled Medicare patients (aRR 0.42). Prescriptions that followed CDC guidelines were less likely to be associated with long-term use in most of the populations and settings analyzed.

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High-dose prescriptions were relatively common in both settings. In the commercially insured population, opioid prescriptions exceeding 50 mg of morphine equivalent or higher per day were noted in 22.8% of patients in the non-ED setting and 14% of patients in the ED setting.

In an interview with Clinical Pain Advisor, Molly Jeffery, PhD, scientific director of Emergency Medicine Research at the Mayo Clinic in Rochester, Minnesota, and lead author on the study, called 50 mg of morphine equivalent “an extraordinarily high dose for an opioid-naive patient.”

Dr Jeffery concluded that “in non-ED settings, prescriptions that didn’t follow best practices were associated with more than 4 times the risk of chronic opioid use than those that did follow the best practices.” She therefore hopes that, “clinicians will share this information with their patients when they’re explaining why they’re only giving a 3-day supply of an opioid.”

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Jeffery MM, Hooten WM, Hess EP, et al. Opioid prescribing for opioid-naive patients in emergency departments and other settings: Characteristics of prescriptions and association with long-term use [published online September 25, 2017]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2017.08.042