Despite concerns about overprescribing of opioids in the emergency room, a new study finds that emergency physicians don’t hand out painkillers like candy.
Indeed, compared to other medical settings, patients who are prescribed opioids for the first time in the emergency department are less likely to become long-term users, according to a paper published today in the Annals of Emergency Medicine.
Researchers analyzed 5.2 million prescriptions for opioids and found that prescriptions for painkillers that exceeded seven days were 84% to 91% lower than in nonemergency settings.
Furthermore, prescriptions from the ER were 23% to 37% less likely to exceed 50 morphine milligram equivalents and 33% to 54% less likely to exceed a high dose of 90 milligram equivalents. And ER prescriptions were 86% to 92% less likely to be written for long-acting or extended-release formulations than those attributed to nonemergency settings.
"Our paper lays to rest the notion that emergency physicians are handing out opioids like candy," said lead study author Molly Moore Jeffery, Ph.D., scientific director of the Mayo Clinic Division of Emergency Medicine Research in Rochester, Minnesota, in a study announcement. "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."
Regardless of insurance status, researchers found that patients who received opioid prescriptions in the emergency department were less likely to progress to long-term opioid use. Patients with commercial insurance were 46% less likely to progress to long-term opioid use, Medicare patients age 65 and older were 56% less likely to progress to long-term opioid use and patients with disabled Medicare were 58% less likely to progress to long-term use if they received an opioid prescription in the emergency department.
"Over time, prescriptions written in the ER for high dose opioids decreased between 2009 and 2011," said Jeffery. "Less than 5% of opioid prescriptions from the ER exceeded seven 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."