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Persistent Opioid Use After Emergency Department Prescription

December 23, 2019

Written by Rick Ramirez, DNP, APRN

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At 6-months post-ED follow-up, 66% of patients filled only the initial ED prescription they were given, and only 1% met criteria for persistent opioid use (>6 prescriptions at 6 months).

Why does this matter?
Treating acute pain on discharge from the ED with opioid prescriptions is a hot topic. Up to 14% of ED patients are discharged with an opioid. The surge in prescriptions has increased public and media awareness on the issue, and most states have opioid prescribing guidelines. The long-term risks of prescribing opioids to the opioid-naive continues to be of concern.

A moment on the lips, a lifetime on the hips?
Following 484 patients after receiving an opioid prescription in the ED for 6-months by phone and statewide prescription database review, 66% of patients filled only the initial prescription; 21% filled one more prescription; only 1% had filled ≥6 prescriptions (95%CI 0% to 3%). Of the 484, 11% did not fill any prescription (even from the ED). Not surprisingly, 0% of patients reported using illicit substances or non-prescribed opioids. The Opioid Risk Tool misclassified a majority of patients who went on to persistent use as “low risk,” calling into question the validity for ED patients. What does this mean? It was a fairly small study from two EDs in the Bronx, which may limit generalizability. While the results are intriguing, my opioid prescribing practice will continue to be based on the patient’s diagnosis and our shared decision making on appropriate discharge therapies. I think we all can agree that smart prescribing practices, continued pharmacological education, and patient education are keys to success and deterring opioid use.

Opioid Use During the Six Months After an Emergency Department Visit for Acute Pain: A Prospective Cohort Study. Ann Emerg Med. 2019 Nov 1. pii: S0196-0644(19)31134-5. doi: 10.1016/j.annemergmed.2019.08.446. [Epub ahead of print]

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