RICO? Rest, Ice, Compression, Opiate for Ankle Sprain?

September 25, 2018

Written by Vivian Lei

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Although opioids are not first-line treatment for ankle sprains, an opioid was prescribed for 25% of emergency department patients diagnosed with an isolated ankle sprain. Prescribing varied widely among states. Additionally, patients prescribed greater quantities of opioids were more likely to transition to continued use.

Why does this matter?
Most physicians would agree that ankle sprains are a self-limited painful condition in which opioids have little clinical benefit, especially when weighed against the risk of subsequent opioid misuse. However, this data shows that there is significant variability in opioid prescribing habits for this condition.

Rest, ice, ibuprofen…and oxy?
In this study, researchers analyzed private insurance claims data from 30,832 adult patient visits to U.S. emergency departments for an ankle sprain from 2011-2015. Patients were opioid naïve (no opioid prescription in the past 6 months) and had an isolated injury. Overall, 25.1% of patients received a prescription for opioid pain medication. During the study period, there was a small decline in opioid prescription rate from 28.1% in 2011 to 20.4% in 2015. Researchers demonstrated a wide variation across states, ranging from 2.8% in North Dakota to 40% in Arkansas (see figure). Prolonged opioid use (4 or more new opioid prescriptions 30 days after initial prescription) was nearly 5 times more likely in patients prescribed greater than 225 total morphine milligram equivalents (MMEs), or the equivalent of 30 tablets of oxycodone 5 mg. This study suggests that prescribing guidelines for painful conditions may be beneficial in curbing the amount of opioids prescribed.

Source
National Variation in Opioid Prescribing and Risk of Prolonged Use for Opioid-Naive Patients Treated in the Emergency Department for Ankle Sprains. Ann Emerg Med. 2018 Jul 24. pii: S0196-0644(18)30498-0. doi: 10.1016/j.annemergmed.2018.06.003. [Epub ahead of print]

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Reviewed by Clay Smith