Study finds dramatic increase in painkiller prescriptions for ER patients

Researchers at George Washington University have found a significant increase in prescriptions for opioid analgesics, such as Percocet, Vicodin, oxycodone and Dilaudid, despite only a modest increase in visits for painful conditions. The report, published Friday in the journal Academic Emergency Medicine, details the growing rate of painkiller prescriptions between 2001 and 2010.

The trend concerns co-author Dr. Maryann Mazer-Amirshahi, given the increase in opioid-related overdoses in recent years.

“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,” said Mazer-Amirshahi, who is an instructor of emergency medicine at the GW School of Medicine and Health Sciences. “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 emergency department visits where an opioid analgesic was prescribed increased to 31 percent from 20.8 percent. Most strikingly, Dilaudid, one of the most potent and addictive medications, went up 668.2 percent. The percentage of visits for painful conditions during the period only increased by four percent, to 51.1 percent in 2010 from 47.1 percent in 2001.

What could be accounting for such a dramatic shift on what is prescribed during ER visits? Co-author Dr. Jesse Pines suspects that patients have come to expect these types of opioids to treat their pain.

“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 Pines. “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. The study also found:

  • 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 opioid utilization in Northeast states.
  • Opioids more commonly prescribed in urban emergency departments and in nonprofit hospitals.
  • Increases in prescription rates for all opioid analgesics, 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.

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