Emergency Department Contribution to the Prescription Opioid Epidemic - 17/05/18
, Seth A. Seabury, PhD b, c, Michael Menchine, MD, MPH aAbstract |
Study objective |
We characterize the relative contribution of emergency departments (EDs) to national opioid prescribing, estimate trends in opioid prescribing by site of care (ED, office-based, and inpatient), and examine whether higher-risk opioid users receive a disproportionate quantity of their opioids from ED settings.
Methods |
This was a retrospective analysis of the nationally representative Medical Expenditure Panel Survey from 1996 to 2012. Individuals younger than 18 years and with malignancy diagnoses were excluded. All prescriptions were standardized through conversion to milligrams of morphine equivalents. Reported estimates are adjusted with multivariable regression analysis.
Results |
From 1996 to 2012, 47,081 patient-years (survey-weighted population of 483,654,902 patient-years) surveyed by the Medical Expenditure Panel Survey received at least 1 opioid prescription. During the same period, we observed a 471% increase in the total quantity of opioids (measured by total milligrams of morphine equivalents) prescribed in the United States. The proportion of opioids from office-based prescriptions was high and increased throughout the study period (71% of the total in 1996 to 83% in 2012). The amount of opioids originating from the ED was modest and declined throughout the study period (7.4% in 1996 versus 4.4% in 2012). For people in the top 5% of opioid consumption, ED prescriptions accounted for only 2.4% of their total milligrams of morphine equivalents compared with 87.8% from office visits.
Conclusion |
Between 1996 and 2012, opioid prescribing for noncancer patients in the United States significantly increased. The majority of this growth was attributable to office visits and refills of previously prescribed opioids. The relative contribution of EDs to the prescription opioid problem was modest and declining. Thus, further efforts to reduce the quantity of opioids prescribed may have limited effect in the ED and should focus on office-based settings. EDs could instead focus on developing and disseminating tools to help providers identify high-risk individuals and refer them to treatment.
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| Please see page 660 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: SAS provided statistical advice on study design. MM provided clinical expertise and advice on study design. SA obtained and analyzed the data. MM and SA drafted the article. All authors conceived the study and contributed substantially to article revision. SA takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. Drs. Seabury and Menchine report receiving support from a Health Policy grant from the Emergency Medicine Foundation. Dr. Seabury reports receiving support from an unrestricted department grant from Research to Prevent Blindness, New York, NY. Dr. Axeen reports receiving support from a grant from the Agency for Healthcare Research and Quality (1R36HS024251-01). |
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| The funders had no role in the design or conduct of the study. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 71 - N° 6
P. 659 - juin 2018 Retour au numéro
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- Information for Readers
- The Supply of Prescription Opioids: Contributions of Episodic-Care Prescribers and High-Quantity Prescribers
- Todd Schneberk, Brian Raffetto, David Kim, David L. Schriger
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