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Study: EDs Bear Little Blame for Increase in Opioid Prescribing, Misuse

A new study confirms what emergency medicine staffers have been saying for years: They are getting a bad rap about their role in opioid prescribing.

In fact, the article in Annals of Emergency Medicine suggests that legislative and regulatory actions limiting painkiller prescriptions in emergency departments (EDs) are likely misguided and divert attention away from the real problems.

While researchers from the University of Southern California (USC) Schaeffer Center for Health Policy and Economics and Keck School of Medicine of USC found that opioid prescribing shot up 471% from 1996 to 2012, the portion prescribed in EDs was small to begin with and actually declined from 7.4% percent to 4.4% over the time period.

On the other hand, the share of opioids prescribed by physicians’ offices was larger and increased from 71% to 83% over those years, study authors point out.

“One hypothesis has been that the emergency room is a recurrent site of care and that patients could be going from ER to ER to obtain multiple prescriptions to support their addiction,” explained lead author Sarah Axeen, PhD, an assistant professor of emergency medicine at the Keck School of Medicine and researcher at the USC Schaeffer Center. “But our analysis shows that emergency rooms account for a very small share of all prescribed opioids. In fact, doctor's offices are the source of many more of these drugs.”

On average, the study found that, of opioids prescribed:

  • 44% were from outpatient physician offices;
  • 26% were from dental offices and other outpatient sites;
  • 16% were from EDs; and
  • 14% were from inpatient hospital settings.

Researchers also determined that ED opioid prescribing was especially low for high-risk users, who make up the top 5% of annual opioid consumption. High-risk users obtained 2.4% of their opioids from EDs compared to 87.8% from physician offices.

Overall, the study notes, 80% of the chronic and high-strength dosage prescriptions were from office settings.

Data analyzed in the study came from the annual, nationally representative Medical Expenditure Panel Survey of patients, which is conducted by the U.S. Department of Health and Human Services.


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