Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use

• Published in: Annals of emergency medicine 2018-03, Vol.71 (3), p.326-336.e19
• Main Authors: Jeffery, Molly Moore, Hooten, W. Michael, Hess, Erik P., Meara, Ellen R., Ross, Joseph S., Henk, Henry J., Borgundvaag, Bjug, Shah, Nilay D., Bellolio, M. Fernanda
• Format: Article
• Language: English
• Subjects: Adult; Aged; Drug Prescriptions - statistics & numerical data; Emergency Service, Hospital; Female; Follow-Up Studies; Humans; Incidence; Male; Medicare Part D - statistics & numerical data; Middle Aged; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Practice Patterns, Physicians; Retrospective Studies; Risk Factors; Socioeconomic Factors; Time Factors; United States - epidemiology
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2017.08.042

We explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients’ continuing long-term opioid use. We used analysis of administrative claims data (OptumLabs Data Warehouse 2009 to 2015) of opioid-naive privately insured and Medicare Advantage (aged and disabled) beneficiaries to compare characteristics of opioid prescriptions attributed to the ED with those attributed to other settings. Concordance with Centers for Disease Control and Prevention (CDC) guidelines and rate of progression to long-term opioid use are reported. We identified 5.2 million opioid prescription fills that met inclusion criteria. Opioid prescriptions from the ED were more likely to adhere to CDC guidelines for dose, days’ supply, and formulation than those attributed to non-ED settings. Disabled Medicare beneficiaries were the most likely to progress to long-term use, with 13.4% of their fills resulting in long-term use compared with 6.2% of aged Medicare and 1.8% of commercial beneficiaries’ fills. Compared with patients in non-ED settings, commercial beneficiaries receiving opioid prescriptions in the ED were 46% less likely, aged Medicare patients 56% less likely, and disabled Medicare patients 58% less likely to progress to long-term opioid use. Compared with non-ED settings, opioid prescriptions provided to opioid-naive patients in the ED were more likely to align with CDC recommendations. They were shorter, written for lower daily doses, and less likely to be for long-acting formulations. Prescriptions from the ED are associated with a lower risk of progression to long-term use.