Administration of and Prescribing Opioids in Emergency Departments: A Retrospective Study

Authors

  • Casey L. McNeil, M.D., Ph.D.
  • Alma Habib, M.D. University of Minnesota
  • Hayrettin Okut, Ph.D. University of Kansas School of Medicine-Wichita
  • Sheryl Beard, M.D. Ascension Via Christi & University of Kansas School of Medicine-Wichita
  • Elizabeth Ablah, Ph.D., MPH University of Kansas School of Medicine-Wichita
  • Stephanie Hassouneh, MS-2

DOI:

https://doi.org/10.17161/kjm.vol1413368

Keywords:

opioids, emergency departments, best practices, Kansas

Abstract

Opioid overdose was a cause of 42,249 deaths in the United States in 2016 (13.3 deaths per 100,000) and contributed to 67.8% of all drug overdose deaths in the USA in 2017.1,2 The rate of drug overdose resulting in death in Kansas in 2016 was 11.8 per 100,000, (333 total drug overdose deaths).2 Emergency departments (EDs) are a key intermediary in opioid prescriptions.  In 2010, 31% of ED visits nationally resulted in an opioid prescription.3

The number of opioid prescriptions from an ED varies greatly even for a single medical indication.  For example, states varied from 40% to 2.8% of patients being prescribed an opioid medication from the ED for ankle sprains among opioid-naive patients treated from 2011 to 2015.4 In Kansas, 35.7% of ankle sprain patients received an opioid prescription from an ED.4 

Guidelines for acute pain, including the Alternatives To Opioids protocol (ALTO)5 and the Center for Disease Control and Prevention’s Chronic Pain Guidelines (CDC-CPG)6 are available to guide opioid medication decisions.  The ALTO protocol can be used to guide administration and prescription of analgesics for indications that include headache/migraine, musculoskeletal pain, renal colic, abdominal pain, bone fracture, and joint dislocation. The protocol encourages the use of analgesics such as acetaminophen, ibuprofen, and ketorolac prior to opioid administration.5 The CDC-CPG guides the provider into setting goals for pain control, discussing appropriate risks and benefits with the patients, and setting criteria for minimizing long-term opioid use,6 but defers to the American College of Emergency Physician’s 2012 clinical policy guideline for opioid management of chronic pain in the ED. The ACEP recommends against prescribing opioids for acute exacerbation of chronic pain in the ED [Level C recommendation].7

Adopting opioid prescribing guidelines has drastically reduced opioid prescribing rates in some locations.8  For example, a study performed in both a community and an academic medical center tested the implementation of an opioid prescribing guideline that resulted in a decline of opioid prescriptions from 52.7% to 29.8% of patient visits.8  Even in a hospital with less frequent opioid prescribing practices, adopting guidelines has reduced opioid administration in the ED from 22.5% to 17.7%.9  In 2017, 17 states had adopted opioid prescription guidelines10; however, Kansas is not one of those states.

Knowing little of opioid prescribing practices in Wichita, Kansas, the purpose of this study was to identify factors that are associated with opioid administration and prescriptions in EDs in Wichita, Kansas, and to evaluate what methods are used by local prescribers to limit opioid administration and prescription in a locality without an opioid prescribing guideline.

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Published

2021-01-21

Issue

Section

Original Research