Prescription Opioid Use in General and Pediatric Emergency Departments

Menchine, Michael; Lam, Chun Nok; Arora, Sanjay

doi:10.1542/peds.2019-0302

Cited by 10 publications

(16 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…NSAIDs are associated with gastrointestinal bleeding and unfavorable cardiovascular events [ 7 ], while opioids are related to dependence, addiction and abuse, particularly when used for chronic non-oncological pain [ 8 , 9 ]. Previous opioid use is an important risk factor for future opioid misuse, even when opioids are prescribed for a medical indication [ 10 ]. The misuse of analgesics contributes to increased morbidity and mortality rates, deterioration of quality of life, greater demand for health resources, and increased health care costs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Prescribing Pattern of Analgesics in Colombia. Are there Differences between Capital Cities and Municipalities? A Cross-Sectional Study

Valladales‐Restrepo

Rubio-Londoño

Poveda-Martinez

et al. 2022

Drugs - Real World Outcomes

View full text Add to dashboard Cite

Background Analgesics provide multiple clinical benefits but they are not without risks. Objective The aim of this study was to compare the outpatient prescribing pattern of analgesics between cities and municipalities in Colombia and to identify the variables associated with prescribing opioid analgesics. Methods This was a cross-sectional study that identified the prescription of analgesics for outpatient use from a population database of 8.5 million Colombians. A descriptive, bivariate, and multivariate analysis was performed. Results A total of 573,248 patients were identified who had received prescriptions for an analgesic. Mean age was 46.5 ± 23.6 years and 65.7% were females. The most commonly prescribed analgesics were non-opioid analgesics, antispasmodics, and opioid analgesics. The average milligram equivalent of morphine was higher in capital cities than in municipalities. Age ≥ 65 years (odds ratio [OR] 2.60, 95% confidence interval [CI] 2.54-2.67), male sex (OR 1.09, 95% CI 1.07-1.11), dispensing in cities (OR 2.25, 95% CI 2.20-2.30) and experiencing chronic pain (OR 13.25, were associated with an increased risk of receiving an opioid analgesic. Conclusions Differences were found in the prescription of analgesics between capital cities and municipalities. The use of opioids does not appear to be in line with the recommendations for clinical practice, and they were mainly prescribed for elderly males with chronic non-oncological pain and for residents of capital cities.

show abstract

Section: Introductionmentioning

confidence: 99%

Prescribing Pattern of Analgesics in Colombia. Are there Differences between Capital Cities and Municipalities? A Cross-Sectional Study

Valladales‐Restrepo

Rubio-Londoño

Poveda-Martinez

et al. 2022

Drugs - Real World Outcomes

View full text Add to dashboard Cite

show abstract

“…Because the NHAMCS does not delineate pediatric versus general EDs, a surrogate variable was created to account for this limitation, as has been done in previous studies. 29 , 30 …”

Section: Methodsmentioning

confidence: 99%

Predictors of Emergency Department Opioid Use Among Adolescents and Young Adults

2022

View full text Add to dashboard Cite

It is well established that adolescents and young adults are increasingly vulnerable to the effects of early opioid exposures, with the emergency department (ED) playing a critical role in such introduction. Our objective was to identify predictors of ED opioid administration (ED-RX) and prescribing at discharge (DC-RX) among adolescent and young adults using a machine learning approach.Methods: We conducted a secondary analysis of ED visit data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2018. Visits where patients were aged 10 to 24 years were included. Predictors of ED-RX and DC-RX were identified via machine learning methods. Separate weighted logistic regressions were performed to determine the association between each predictor, and ED-RX and DC-RX, respectively.Results: There were 12,693 ED visits identified within the study time frame, with the majority being female (58.6%) and White (70.7%). Approximately 12.3% of all visits were administered an opioid during the ED visit, and 11.5% were prescribed one at discharge. For ED-RX, the strongest predictors were fracture injury (odds ratio [OR], 5.24; 95% confidence interval [CI], 3.73-7.35) and Southern geographic region (OR, 3.01; 95% CI, 2.14-4.22). The use of nonopioid analgesics significantly reduced the odds of ED-RX (OR, 0.46; 95% CI, 0.37-0.57). Fracture injury was also a strong predictor of DC-RX (OR, 5.91; 95% CI,, in addition to tooth pain (OR, 5.47; 95% CI, 3.84-7.69).Conclusions: Machine learning methodologies were able to identify predictors of ED-RX and DC-RX, which can be used to inform ED prescribing guidelines and risk mitigation efforts among adolescents and young adults.

show abstract

“…Overall, in an Emergency Department (ED) perspective, children's and adolescents' prescriptions have increased as much as 30% from 2001 to 2010 in the US, partly contributing to the spread of the opioid epidemic [6]. However, the number of outpatient opioid prescriptions in the Paediatric Emergency Departments is limited and significantly lower than that observed in children admitted to the General Emergency Departments [7].…”

Section: Textmentioning

confidence: 99%

The risks of physicians’ conformism: reflections from the opioid overflow

2021

View full text Add to dashboard Cite

Opioid-related mortality in adolescents is spreading in the US, with prescription opioids playing a crucial role in the development of addiction. We traced back to the process leading to the so called “opioid overflow”, trying to identify any modifiable attitude.Since the late 1990s, pain was labelled as the “fifth vital sign” and its proper management was prompted, encouraging the use of opioids for any pain scored at a Numerical Rating Scale (NRS) of 7 or higher. This assumption has some remarkable limitations. NRS is a proxy of pain severity in children, and pain measurement should be strengthened by a more comprehensive pain evaluation. Moreover, while remaining a fundamental therapeutic right of patients suffering postoperative or chronic severe pain, opioids show no evidence of superiority respect to non-opioid regimens in the management of pain from several acute conditions.Italy, as other European countries, is often reluctant to the use of opioids, even when highly recommendable, missing the opportunity of properly treating those selected patients with severe pain. Both attitudes can be viewed as the result of an extreme simplification of the complex process of pain evaluation and treatment, by means of a ‘one-size-fits-all’ approach.This highlights the need for a systematic and patient-tailored attitude to children in pain, avoiding applying guidelines without question. Good clinical practice must rely on guidelines, which, however, as often based on partial and insufficient data, can be questioned by emerging new evidence, and should not substitute our rational thinking, and capability to understand each patient, avoiding excessive conformism.

show abstract

Prescription Opioid Use in General and Pediatric Emergency Departments

Cited by 10 publications

References 45 publications

Prescribing Pattern of Analgesics in Colombia. Are there Differences between Capital Cities and Municipalities? A Cross-Sectional Study

Prescribing Pattern of Analgesics in Colombia. Are there Differences between Capital Cities and Municipalities? A Cross-Sectional Study

Predictors of Emergency Department Opioid Use Among Adolescents and Young Adults

The risks of physicians’ conformism: reflections from the opioid overflow

Contact Info

Product

Resources

About