Written by Jason Lesnick
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From 2016 to 2022, the rates of opioid administration in the ED and opiates prescribed after ED visits declined.
Down with opiates! Well, at least prescribing unnecessarily…
This retrospective observational study investigated trends of opiate and non-opiate analgesic administration between 2016 and 2022 in U.S. EDs.
The study used the National Hospital Ambulatory Medical Care Survey (NHAMCS) as their data source, which included almost 1 billion ED visits. The authors found ED opioid administration (either in the ED, prescribed at discharge, or both) declined from 22.4% to 13.9% (absolute −8.5%, 95%CI −10.2 to −6.8; p<0.001). The frequency of opiates prescribed fell from 13.0% in 2016 to 5.9% in 2022 (−7.1%, p<0.001), while nonopioid use remained stable overall.
Notably, there was no difference in overall (non-ED) rates of non-opioid analgesic administration during the study period: 31.2% in 2016 to 33.4% in 2022 (95%CI -1.0 to 4.6%, p = 0.220). There was, however, an increase in the frequency of non-opioid analgesic administration in the ED from 21.8% to 26.0% (95% CI 1.6 to 6.6%, p = 0.001).
The authors also provided a breakdown on specific opiates used and analyzed the data by type of pain. They were unable to comment on the appropriateness of opiate prescribing practices, as these data lack detail about pain severity, medication dosage, frequency, route of administration, or duration of treatment.
How will this change my practice?
This paper further encourages my practice of taking time to educate my patients on the value of non-opiate analgesic options and using these whenever appropriate instead of defaulting to opiates for everyone with pain.
Source
Decreasing Rates of Opioid Administration in the Emergency Department: Trends in National Opioid Prescribing Patterns From 2016 to 2022. J Emerg Med. 2025 Dec;79:577-590. doi: 10.1016/j.jemermed.2025.10.011. Epub 2025 Oct 10. PMID: 41242068.
View JournalFeed Critical Appraisal
Critical Appraisal
Study Identification
Background
Study Question
Study Design & Conduct
Prospective / Retrospective: Retrospective
Multicenter: Yes
Unit of Allocation: Not applicable
Unit of Analysis: ED visits
Randomization Method: Not applicable
Allocation Concealment: Not applicable
Blinding: Not applicable
Follow-up Duration: Not applicable
Population
- ED visits recorded in NHAMCS from 2016 to 2022
- Not reported
Number Enrolled: 991,668,111 weighted ED visits
Number Analyzed: 991,668,111 weighted ED visits
Key Baseline Characteristics
Sex: Not reported
Disease Severity: Not reported
Care Setting Distribution: Nationally representative ED visits
Exposures / Interventions
Description: Opioid and nonopioid analgesic use in EDs
Definition / Dose: Defined using Multum Lexicon codes
Timing: During ED visit or at discharge
Classification Method: Standardized coding
Protocolized / Discretionary: Not applicable
Description: Trends over time
Definition: Comparison of opioid and nonopioid use from 2016 to 2022
Outcomes & Results
Primary Outcomes
Definition: Visits where opioids were administered or prescribed
Time Point: 2016 to 2022
Measurement Method: Survey-weighted analysis
Results: Declined from 22.4% to 13.9%
Secondary Outcomes
Definition: Visits where nonopioid analgesics were administered
Time Point: 2016 to 2022
Measurement Method: Survey-weighted analysis
Results: Increased slightly in some subgroups
Risk of Bias
Risk of Bias - ROBINS-I
- Confounding (Low): The study adjusted for major confounders using subgroup analyses.
- Selection of Participants (Low): Participants were selected from a large, representative national dataset.
- Classification of Interventions (Low): Interventions were clearly defined using standardized codes.
- Deviations from Intended Interventions (Low): No deviations reported as the study is observational.
- Missing Data (Low): Data completeness was ensured through the use of a comprehensive national survey.
- Measurement of Outcomes (Low): Outcomes were measured using standardized and validated methods.
- Selection of the Reported Result (Low): All relevant outcomes were reported, reducing the risk of selective reporting.
Transparency
COI Statement Present: TRUE
