Temporal Factors Associated With Opioid Prescriptions for Patients With Pain Conditions in an Urban Emergency Department

Abstract

IMPORTANCEOpioid prescriptions for treatment of pain in emergency departments (EDs) are associated with long-term opioid use. The temporal pattern of opioid prescribing in the context of the opioid epidemic remains unknown. OBJECTIVE To examine the temporal pattern of opioid prescribing within an ED for varying pain conditions between 2009 and 2018. DESIGN, SETTING, AND PARTICIPANTS A population-based, cross-sectional study was conducted at the ED of an urban academic medical center. All patients treated within that ED between January 1, 2009, and December 31, 2018, were included. MAIN OUTCOMES AND MEASURESThe proportion of patients prescribed an opioid for treatment of pain in the ED temporally by condition, condition type, patient demographics, and physician prescriber.

Opioid Deprescribing in Emergency Medicine—A Tool in an Expanding Toolkit

“…As likely is operative in the study by Smith et al, 1 Downloaded From: https://jamanetwork.com/ on 10/11/2020 for many patients. 5 Not only are these alternatives effective analgesics for most patients, they also avoid the unintended messaging that opioids are the only effective pain management modality.…”

“…Although its latest evolution involves epidemic-level deaths from illicitly manufactured fentanyl and its analogues, the origin of the crisis can be definitively traced to the overprescribing of prescription opioids. Although broad-based efforts across all specialties have resulted in substantial reductions in opioid prescribing, the study by Smith et al 1 demonstrates that efforts in their emergency department (ED) outpaced any secular trend. Their study evaluated opioid prescribing in an urban, academic ED and found a 66.3% decline between 2013 and 2018 for a variety of painful conditions, a rate substantially greater than those reported in previous studies and in national data.…”

“…Perhaps because Smith et al 1 are not emergency physicians, the process leading to their institution's success is not described in detail. It is worthwhile to highlight that the specialty of emergency medicine has addressed analgesia and its consequences and that many of these efforts generalize to other clinical departments and across the health care continuum.…”

“…Notably, through the use of a stewardship model, EDs and health care systems have sought to address the spectrum of harms associated with opioid use 6. While the study by Smith et al1 focused on the success of 1 aspect of opioid stewardship (ie, deprescribing), stewardship programs also address harm reduction (eg, naloxone prescribing and distribution) and treatment engagement (eg, buprenorphine prescribing).Increasingly, EDs are leading to treatment by credentialing a cadre of clinicians who are ready to engage patients in the treatable moment that may accompany an ED visit. This includes a focus on withdrawal management with buprenorphine, warm hand-off programs, bridge clinics, and direct initiation of buprenorphine therapy 7.…”

Does Inhaled Methoxyflurane Implement Fast and Efficient Pain Management in Trauma Patients? A Systematic Review and Meta-Analysis

“…Studies have documented that effective trauma pain management is very important for enhancing patient therapeutic compliance, quality of life, and satisfactory outcomes, which leads to shorter hospital stays [4,5]. Traditional pharmacotherapeutic options for acute pain in trauma settings include different kinds of opioid and non-opioid drugs (e.g., morphine, nitrous oxide, non-steroidal anti-inflammatory drugs) [6][7][8]. However, evidence suggests that these drugs confer an increased likelihood of bleeding, mood disorders, and death in trauma patients [9][10][11].…”