CHICAGO – When opioids were prescribed for noncancer pain in emergency departments, the doses and numbers of pills prescribed were lower than those prescribed in office-based practices, Dr. Michael D. Menchine reported at the annual meeting of the American College of Emergency Physicians.
One in 400 opioid prescriptions written in the ED were for at least 100 morphine milligram equivalent (MME) daily doses; in office settings, the comparable rate was 1 in 39 prescriptions, based on an analysis of the Medical Expenditure Panel Survey(1997-2011), a nationally representative subsurvey of the annual National Health Interview Survey.
The findings indicate efforts to reduce risky opioid prescribing should focus mainly on office-based and not ED-based settings, said Dr. Menchine of the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles. They also raise questions about whether emergency physicians are underprescribing opioids.
Dr. Michael D. Menchine
For their study, the researchers examined where each opioid prescription was generated and used the National Drug Code to determine the exact compounds and doses prescribed, which were converted to MME doses. Patients with ICD-9 codes indicating a history of malignancy were excluded from the study.
The number of high-risk prescriptions, defined as doses of at least 100 MME daily, were identified by source of care for 44,313 unique individuals receiving 164,406 opioid prescriptions during the study period. The mean age of individuals included in the study was 48 years and 63% of the study participants were female.
After researchers adjusted for patient demographic features and diagnosis categories, the average opioid prescription originating from the ED dispensed 44% fewer pills than prescriptions from office visits (95% confidence interval, –0.47 to –0.41; P < .001). On average, the compound prescribed from the ED had 17% lower MME than did those from office visits (95% CI, –0.2 to –0.15; P < .001).
Overall, 1.9% of all opioid prescriptions were for more than 100 MME daily. However, compared with office settings, ED prescriptions were much less likely to be for greater than 100 MME per day (0.26% vs. 2.62% [odds ratio, 0.09; 95% CI 0.05-0.19, P < .001]).
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