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Less Long-term Use When Opioids Initially Prescribed at ED

Despite efforts in the past to blame emergency medicine for the nation’s opioid epidemic, a new study finds that patients who are prescribed opioids for the first time in the emergency department (ED) are much less likely to become long-term narcotics users.

An article published online by Annals of Emergency Medicine notes that EDs are also more likely to prescribe the drugs in line with the Centers for Disease Control and Prevention (CDC) guidelines.

Those findings were based on analysis of 5.2 million prescriptions for opioids.

“Our paper lays to rest the notion that emergency physicians are handing out opioids like candy,” said lead study author Molly Moore Jeffery, PhD, scientific director of the Mayo Clinic Division of Emergency Medicine Research. “Close adherence to prescribing guidelines may help explain why the progression to long-term opioid use is so much lower in the ER. Most opioid prescriptions written in the emergency department are for shorter duration, written for lower daily doses, and less likely to be for long-acting formulations.”

Researchers determined that, in the ED, opioid prescriptions for longer than seven days were 84% to 91% less common and were 86% to 92% less likely to be written for long-acting or extended-release formulations, compared to nonemergency settings.

ED-prescribed dosages were also 23% to 37% less likely to exceed 50 morphine milligram equivalents and 33% to 54% less likely to exceed 90 milligram equivalents than other clinical settings.

The result? Patients receiving opioid prescriptions in the ED were, across the board, less likely to fall into long-term opioid use.

The percentage of patients receiving opioids at the ED progressing to long-term use by insurance follows:

  • 1.1% with private insurance
  • 3.1 percent with regular Medicare
  • 6.2% with Medicare disability

That means that patients with commercial insurance were 46% less likely to progress to long-term opioid use — and Medicare patients age 65 and older were 56% less likely, and those with disabled Medicare were 58% percent less likely — if their initial opioid prescription was received at an ED.

“Over time, prescriptions written in the ER for high dose opioids decreased between 2009 and 2011,” Jeffery explained. “Less than 5 percent of opioid prescriptions from the ER exceeded 7 days, which is much lower than the percentage in nonemergency settings. Further research should explore how we can replicate the success of opioid prescribing in emergency departments in other medical settings.”