New Opiate Prescriptions and Downstream Risk of Misuse

August 6, 2019

Written by Clay Smith

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In patients given a new opiate prescription in the ED, 13.7% had persistent or high-risk use over the next year. Higher doses led to greater risk, but even lower doses were associated with up to a 10% risk.

Why does this matter?
Prior research indicates that for every 48 patients given a short-term opiate prescription in the ED, 1 becomes a long-term opiate user. That study found an association with high-intensity prescribers and long-term use. What is the risk and what are the risk factors for downstream opiate problems when a new opiate prescription is started the ED?

Risk from Rx
This was a Medicaid database from Washington state with 202,809 ED visits in 2014, of which 23,381 had a new opiate prescription filled within one day of an ED visit. Of these opiate-naive patients with a new opiate prescription, 13.7% had persistent or high-risk opiate use within the next 12 months, compared to a baseline 3.2% in patients who did not receive a new opiate prescription. Those with the highest conversion rates to persistent or high-risk use were: patients given a dose ≥350MME, history of substance abuse, and those with non substance-related behavioral health disorders. Over 10% had persistent or high-risk use even when lower doses were prescribed. Make sure the benefit for controlling severe pain is worth the potential risk of persistent use or subsequent opiate misuse, and keep the dose as low as possible. Use special caution in patients with prior substance use or behavioral health disorders.

Source
Conversion to Persistent or High-Risk Opioid Use After a New Prescription From the Emergency Department: Evidence From Washington Medicaid Beneficiaries. Ann Emerg Med. 2019 Jun 20. pii: S0196-0644(19)30310-5. doi: 10.1016/j.annemergmed.2019.04.007. [Epub ahead of print]

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Reviewed by Thomas Davis