Patients Treated by Higher-Intensity Opioid-Prescribing Emergency Physicians Are More Likely to Develop Persistent Opioid Use

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.

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