Researchers find significant increase in painkillers prescribed to US adults visiting emergency departments

March 14, 2014

(Medical Xpress)—George Washington University (GW) researchers report dramatic increases in prescriptions of opioid analgesics, such as Percocet, Vicodin, oxycodone and Dilaudid, during U.S. emergency department visits from 2001 to 2010. These findings were not explained by higher visit rates for painful conditions, which only increased modestly during the time period. This report was published today in the journal Academic Emergency Medicine.

"This trend is especially concerning given dramatic increases in opioid-related overdoses and fatalities in recent years," said Maryann Mazer-Amirshahi, M.D., co-author of the study and adjunct instructor of medicine at the GW School of Medicine and Health Sciences (SMHS). "Using prescription opioids to treat acute painful conditions in emergency departments and hospitals might do more harm than good, as they can potentially lead to misuse and addiction. More needs to be done to monitor opioid prescriptions in emergency departments—having recommended standard approaches may be a good starting point."

Mazer-Amirshahi and colleagues found that between 2001 and 2010, the percentage of overall visits where an opioid analgesic was prescribed increased from 20.8 percent to 31 percent. For some opioids, prescription rates increased dramatically; Dilaudid, one of the most potent yet addictive medications, went up 668.2 percent. The percentage of visits for painful conditions during the period only increased by four percent, from 47.1 percent in 2001 to 51.1 percent in 2010.

"Emergency department providers are often caught in a difficult position because some have their pay incentivized based on how patients report their satisfaction with their experience. The intention is always to provide appropriate pain relief, but many patients have come to expect opioids," said Jesse Pines, M.D., co-author of the study and director of the Office of Clinical Practice Innovation at GW SMHS. "When patients in pain want opioids, but don't get them—which is common—they may report a poor experience. We need to carefully consider how to balance these issues when it comes to national policy, particularly local and national payment policies, in this country."

The study analyzed data from the National Hospital Ambulatory Medical Care Survey, exploring which demographic groups, medications, and reasons for visiting the emergency room may account for this change in prescribing rates. In their analysis, the authors found the following over the ten-year study period:

  • Opioid prescribing increases across all age groups, including those over 65 years
  • Increases in opioid use in both blacks and whites; however, blacks were consistently prescribed fewer opioids than whites
  • Significant increases in opioid use in all categories of payer
  • Largest proportional increase in opioid prescriptions in Midwestern states; Highest overall frequency of opioids prescribed in Western states; Lowest rates of utilization in Northeast states
  • Opioids more commonly prescribed in urban emergency departments and in nonprofit hospitals
  • Increases in prescription rates for all , except codeine and meperidine
  • Greatest relative increases in use of hydromorphone (known as Dilaudid) and morphine; Hydromorphone and oxycodone had the greatest relative increases from 2005-2010

Explore further: Repeat ED visits for opioid overdose raise risk of hospitalization, respiratory failure

More information: The paper, titled "Rising Opioid Prescribing in Adult U.S. Emergency Department Visits: 2001-2010," is available at onlinelibrary.wiley.com/doi/10 … /acem.12328/abstract

Related Stories

Repeat ED visits for opioid overdose raise risk of hospitalization, respiratory failure

March 11, 2014
Patients brought to hospital emergency departments (EDs) more than once in a year for treatment of opioid drug overdoses are more likely to be hospitalized for overdose and to need respiratory support with a mechanical ventilator. ...

Prescriptions for opioids stabilizing after fivefold increase in ten-year span

March 11, 2014
Death rates from opioids have been soaring in the U.S. since the 1990s. To support the appropriate use of these controlled substances and inform public health interventions to prevent drug abuse, most states have implemented ...

Sharp rise in opioid drugs prescribed for non-cancer pain, study reports

September 16, 2013
Prescribing of strong opioid medications for non-cancer pain in the United States has nearly doubled over the past decade, reports a study in the October issue of Medical Care.

Study: Access to health care increases prescription opioid availability and associated abuse

November 5, 2013
Researchers at Indiana University-Purdue University Indianapolis say one way to gauge the extent of prescription opioid pain reliever abuse in any Indiana county is to count the number of health care providers, particularly ...

Using storytelling to combat the prescription opioid abuse epidemic

March 3, 2014
(Medical Xpress)—In the fight against a nationwide prescription opioid abuse epidemic, Penn Medicine researchers are using storytelling to help doctors recall important, potentially lifesaving national guidelines on how ...

Recommended for you

Sensor-equipped pill raises technological, ethical questions

November 17, 2017
The first drug with a sensor embedded in a pill that alerts doctors when patients have taken their medications was approved by the Food and Drug Administration, raiding issues involving privacy, cost, and whether patients ...

New painkillers reduce overdose risk

November 16, 2017
Scientists on the Florida campus of The Scripps Research Institute (TSRI) have developed new opioid pain relievers that reduce pain on par with morphine but do not slow or stop breathing—the cause of opiate overdose.

Separating side effects could hold key for safer opioids

November 16, 2017
Opioid pain relievers can be extremely effective in relieving pain, but can carry a high risk of addiction and ultimately overdose when breathing is suppressed and stops. Scientists have discovered a way to separate these ...

US regulators approve first digital pill to track patients

November 14, 2017
U.S. regulators have approved the first drug with a sensor that alerts doctors when the medication has been taken, offering a new way of monitoring patients but also raising privacy concerns.

Introduction is different, but top medications for opioid addiction equally effective

November 14, 2017
With opioid addiction officially declared a public health emergency in the U.S., medical intervention to treat the illness is increasingly important in responding to the epidemic. Now, a new study concludes that two of the ...

Drugstore pain pills as effective as opioids in ER patients

November 7, 2017
Emergency rooms are where many patients are first introduced to powerful opioid painkillers, but what if doctors offered over-the-counter pills instead? A new study tested that approach on patients with broken bones and sprains ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.