Opioid Prescribing in the ER: Are Guidelines Being Followed?
In a study published in the Annals of Emergency Medicine, researchers found that the majority of opioid prescriptions in the emergency department (ED) setting had a low pill count and were nearly all immediate-release formulations rather than long-acting medications.
Scott G. Weiner, MD, MPH, of Brigham and Women's Hospital, and collaborators designed an observational, multicenter, retrospective cohort study to gather data on opioid prescribing to consecutive patients presenting to 19 EDs during one week in October 2012. Of the 27,516 patient visits that were reviewed, 11.9% of all patients and 17% of discharged patients were prescribed an opioid medication. The most common diagnoses associated with opioid prescriptions were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). Over 99% of the opioid prescriptions were for immediate release formulations and 90% were combination preparations; the most commonly prescribed opioids were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%). The mean number of pills per prescription was 15 and only 1.5% of prescriptions were for more than 30 pills.
This research suggests that emergency physicians generally follow guideline recommendations to limit opioid prescriptions to only 3–5 days and avoid long-acting opioids that are more strongly linked to opioid-related overdoses.
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