Increasing prescribing of opioids for acute and chronic pain has led to increasing harms, including opioid use disorder, overdose, and death. Researchers used a database of Medicare beneficiaries to investigate the association between emergency physician opioid-prescribing patterns and the risk of long-term use. They included patients who had not received an opioid prescription in the 6 months prior to the index visit and excluded those in hospice or with a cancer diagnosis. Emergency physicians were classified based on the proportion of visits that led to a filled opioid prescription compared with colleagues at their own institution; those in the highest quartile were defined as “high-intensity” prescribers and those in the lowest quartile as “low-intensity.” The sample included 215,678 patients treated by a low-intensity opioid prescriber and 161,951 treated by a high-intensity prescriber between 2008 and 2011.
- The average rate of opioid prescribing by high-intensity prescribers was 3.3 times higher than that of low-intensity prescribers (24% of visits versus 7%).
- Long-term opioid use (defined as ≥180 days of opioids dispensed in the 12 months after the index visit) was significantly higher among those treated by a high-intensity prescriber (adjusted odds ratio [aOR], 1.30). For every 49 patients prescribed an opioid in the emergency department, 1 developed subsequent long-term use.
- Patients treated by a high-intensity prescriber were more likely to have a hospital encounter for fall or fracture in the 12 months after the index emergency department visit (aOR, 1.07). There was no increase in short-term emergency department visits for inadequately treated pain among those seen by a low-intensity prescriber.
Comments: This study reinforces previous observations that short-term opioid prescribing can lead to long-term use. While we cannot tell how many of the people with long-term use developed problems with opioids, these findings argue for more judicious use of opioids, even in situations where the intent is to prescribe only a short course of treatment.
Darius A. Rastegar, MD
Reference: Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med. 2017;376(7):663–673.