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

Jeffery, Molly Moore; Hooten, W. Michael; Hess, Erik P.; Meara, Ellen; Ross, Joseph S.; Henk, Henry J.; Borgundvaag, Bjug; Shah, Nilay D.; Bellolio, M. Fernanda

doi:10.1016/j.annemergmed.2017.08.042

Cited by 95 publications

(100 citation statements)

References 36 publications

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“…The interpretation of this finding is that for approximately every 26 patients exposed to greater than 225 MME (the equivalent of more than 30 tabs of oxycodone 5 mg) instead of 75 MME or less (equivalent to 10 tablets of oxycodone 5 mg) 1 additional patient transitioned to prolonged use. While there is room for improvement in promoting opioid stewardship for this minor condition in the ED, the majority of prescriptions written were concordant with guidelines for a 3-day supply 12,13,31 and had a low total MME of 100 or less. Therefore, more research is urgently needed to examine the relationship between total MME, prolonged use, and adverse events in other contexts, such as for post-operative pain, where prescriptions are much larger.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, more research is urgently needed to examine the relationship between total MME, prolonged use, and adverse events in other contexts, such as for post-operative pain, where prescriptions are much larger. 12 …”

Section: Discussionmentioning

confidence: 99%

“…To restrict the study population to those who are likely to be prescription opioid-naïve, we excluded all patients who were not continuously enrolled for 6 months prior to the index ED visit and those who had filled an opioid prescription in these prior 6 months. 6,12 …”

Section: Methodsmentioning

confidence: 99%

“…10,11 Second, although initial opioid prescriptions written in the ED are more consistent with current prescribing guidelines than those from non-ED settings and are typically for smaller quantities, (and thus less likely to progress to long-term use), EDs remain a common source of acute opioid prescriptions. 12,13 Finally, there is still significant variability in opioid prescribing by emergency physicians and patient assignment is essentially random. 6,13 This both represents an opportunity for quality improvement and also reduces the potential bias of downstream prescriptions being associated with characteristics of the initial prescriber.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

National Variation in Opioid Prescribing and Risk of Prolonged Use for Opioid-Naive Patients Treated in the Emergency Department for Ankle Sprains

Delgado

Huang

Meisel

et al. 2018

Annals of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

National Variation in Opioid Prescribing and Risk of Prolonged Use for Opioid-Naive Patients Treated in the Emergency Department for Ankle Sprains

Delgado

Huang

Meisel

et al. 2018

Annals of Emergency Medicine

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show abstract

“…This increase in opioid prescription and sales rates is matched by a concomitant upsurge in opioid‐related morbidity, mortality, overdose, and substance abuse treatment admissions, with prescription drug overdose deaths in the United States having quintupled since 1999 . Low back pain (LBP) is a condition that is commonly managed with opioid medication . For conditions such as LBP, continued opioid use has been associated with decreased function and, in some instances, death .…”

Section: Introductionmentioning

confidence: 99%

Differences in Characteristics and Downstream Drug Use Among Opioid‐Naïve and Prior Opioid Users with Low Back Pain

et al. 2018

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Background Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. Objective The primary purpose was to compare characteristics and downstream medication use between patients with LBP with prior opioid exposure vs. those who were opioid-naïve. The secondary purpose was to explore the role of prior opioid use by LBP disability. Methods Seven hundred and nine participants in a LBP self-management class were evaluated utilizing self-report data at baseline and longitudinal claims data from the Military Health System Data Repository. Participants were dichotomized into opioid-naïve and prior opioid use groups and then further divided into low and high disability groups based on Oswestry Disability Index (ODI) scores. Patient characteristics, comorbidities, and medication use were compared between groups. Results Prior opioid users had significantly higher baseline ODI and Fear Avoidance Beliefs Questionnaire physical activity subscale and work subscale scores as well as pre-index instances of mental health disorders, chronic pain, and insomnia than opioid-naïve individuals. Prior opioid users filled significantly more pain medication prescriptions in the year after the index date than did opioid-naïve individuals. Prior opioid users were significantly more likely to be taking opioids at 1 year after the index date, regardless of disability level. Conclusion In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1 year after the index date.

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Prevalence and Risk Factors Associated With Long-term Opioid Use After Injury Among Previously Opioid-Free Workers

et al. 2019

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IMPORTANCE Using opioids for acute pain can lead to long-term use and associated morbidity and mortality. Injury has been documented as a gateway to long-term opioid use in some populations, but data are limited for injured workers. OBJECTIVE To evaluate the prevalence and risk factors of long-term opioid use after injury among workers in Tennessee who were opioid free at the time of injury. DESIGN, SETTING, AND PARTICIPANTS This cohort study identified injured workers aged 15 to 99 years who reported only 1 injury to the Tennessee Bureau of Workers' Compensation from March 2013 to December 2015 and had no opioid prescription in the 60 days before injury. Participants were matched to their prescription history in Tennessee's prescription drug monitoring program. Analysis was conducted from November 2017 to March 2018. Logistic regression models were used to calculate adjusted odds ratios (ORs) and 95% CIs for associations of demographic, injury, and opioid use variables with long-term use. MAIN OUTCOMES AND MEASURES The primary outcome was long-term opioid use, defined as having an opioid supplied for 45 or more days in the 90 days after injury. RESULTS Among 58 278 injured workers who received opioids after injury (18 977 [32.5%] aged 15-34 years, 27 514 [47.2%] aged 35-54 years, and 11 787 [20.2%] aged 55-99 years; 32 607 [56.0%] men), 46 399 (79.6%) were opioid free at the time of injury. Among opioid-free injured workers, 1843 (4.0%) began long-term opioid use. After controlling for covariates, long-term use was associated with receiving 20 or more days' supply in the initial opioid prescription compared with receiving less than 5 days' supply (OR, 28.94; 95% CI, 23.44-35.72) and visiting 3 or more prescribers in the 90 days after injury compared with visiting 1 prescriber (OR, 14.91; 95% CI, 12.15-18.29). However, even just 5 days' to 9 days' supply was associated with an increase in the odds of long-term use compared with less than 5 days' supply (OR, 1.83; 95% CI, 1.56-2.14). CONCLUSIONS AND RELEVANCE In this study of injured workers, injury was associated with longterm opioid use. The number of days' supply of the initial opioid prescription was the strongest risk factor of developing long-term use, highlighting the importance of careful prescribing for initial opioid prescriptions.

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

Cited by 95 publications

References 36 publications

National Variation in Opioid Prescribing and Risk of Prolonged Use for Opioid-Naive Patients Treated in the Emergency Department for Ankle Sprains

National Variation in Opioid Prescribing and Risk of Prolonged Use for Opioid-Naive Patients Treated in the Emergency Department for Ankle Sprains

Differences in Characteristics and Downstream Drug Use Among Opioid‐Naïve and Prior Opioid Users with Low Back Pain

Prevalence and Risk Factors Associated With Long-term Opioid Use After Injury Among Previously Opioid-Free Workers

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