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Hoerster V, Tang D, Milkis M, Litzenberger S, Stoltzfus J, Stankewicz H. Opioid Use and Disposal Patterns of Emergency Department Patients. J Emerg Trauma Shock 2023; 16:177-181. [PMID: 38292287 PMCID: PMC10824224 DOI: 10.4103/jets.jets_55_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/24/2021] [Accepted: 01/20/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction To date, there is limited literature to guide emergency providers (EPs) on the proper dosing of prescription opioids. Our study aims to assess the self-reported opioid use, storage, and disposal practices of patients presenting to the emergency department (ED) with acute pain. Methods This prospective cohort study employed a validated, cross-sectional survey of subjects identified using electronic medical records. The survey link was e-mailed to a continuous sample of eligible participants 3-4 weeks following ED discharge. Nonrespondents were surveyed through telephone after 1 week. We used descriptive and nonparametric statistics to report survey results. Results Of 500 eligible subjects, 97 completed the questionnaire. Only 28% of respondents reported that they took all of the prescribed pills. Of the remaining responses, 20% stated that they did not take any pills, 33% took about one-fourth, 7.2% took about half, and 12.4% took about three-fourths of the pills. Among those who did not take any pills, 42% filled the prescription. Most (71.2%) reported storing their leftover pills; among those who stored their pills, less than one-fourth (23.8%) used a locked storage location. Conclusions Our findings suggest that less than one-third of patients who receive prescriptions in the ED for acute pain use all of their prescribed pills, suggesting that many patients are unnecessarily prescribed opioids for acute conditions. The findings of this study also suggest that many patients with unused prescription opioids do not practice safe storage or proper disposal of leftover pills. This represents a potential opportunity for EPs to improve medication safety by educating patients on proper storage and disposal practices. Limitations include low response rate and the use of self-reporting.
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Affiliation(s)
- Valerie Hoerster
- Department of Emergency Medicine, Sibley Memorial Hospital, Washington, DC, USA
| | - Derek Tang
- Department of Internal Medicine, GME Data Measurement and Outcomes Assessment, St. Luke’s University Health Network, Bethlehem, USA
| | - Marlee Milkis
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, PA, USA
| | | | - Jill Stoltzfus
- Department of St. Luke's University Health Network, GME Data Measurement and Outcomes Assessment, St. Luke’s University Health Network, Bethlehem, USA
| | - Holly Stankewicz
- Department of Emergency Medicine, St. Luke’s University Health Network, Bethlehem, USA
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Patient, Provider, and Clinic Characteristics Associated with Opioid and Non-Opioid Pain Prescriptions for Patients Receiving Low Back Imaging in Primary Care. J Am Board Fam Med 2021; 34:950-963. [PMID: 34535520 PMCID: PMC9746536 DOI: 10.3122/jabfm.2021.05.210033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To describe characteristics of patients, providers, and clinics associated with opioid or non-opioid pain medication prescribing patterns for patients who received lower spine imaging in primary care clinics. METHODS In these secondary analyses of the Lumbar Imaging with Reporting of Epidemiology (LIRE) study, a randomized controlled trial conducted in 4 health systems in the United States, we evaluated characteristics associated with receipt of pain medication prescriptions. The outcomes were receipt of prescriptions for opioid or, separately, non-opioid pain medications within 90 days after imaging. Among patients who received opioid or non-opioid prescriptions, we evaluated receipt of multiple prescriptions in the year following imaging. Mixed models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Compared with whites, patients identified as Asian (OR, 0.53; 95% CI, 0.51-0.56), Native Hawaiian/Pacific Islander (OR, 0.73; 95% CI, 0.64-0.83), multiracial (OR, 0.84; 95% CI, 0.71-0.98) or Black (OR, 0.92; 95% CI, 0.89-0.96) had significantly reduced odds for receiving prescriptions for opioids within 90 days. Patients identified as Native American/Alaska Native had greater odds for receiving prescriptions for non-opioid pain medications within 90 days (OR, 1.12; 95% CI, 1.01-1.24). Receipt of pain prescriptions 120 days before imaging was strongly predictive of subsequent receipt of pain prescriptions across all categories. CONCLUSIONS After adjusting for factors that could affect prescribing, the strongest differences observed in pain-medication prescribing were across racial categories and for patients with previous pain prescriptions. Further research is needed to understand these differences and to optimize prescribing.
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Ali MM, Cutler E, Mutter R, Henke RM, Mazer-Amirshahi M, Pines JM, Cummings N. Opioid prescribing rates from the emergency department: Down but not out. Drug Alcohol Depend 2019; 205:107636. [PMID: 31704377 DOI: 10.1016/j.drugalcdep.2019.107636] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 09/17/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION To examine opioid prescribing rates following emergency department (ED) discharge stratified by patient's clinical and demographic characteristics over an 11-year period. MATERIAL AND METHODS We used 3.9 million ED visits from commercially insured enrollees and 15.2 million ED visits from Medicaid enrollees aged 12 to 64 over 2005-2016 from the IBM® MarketScan® Research Databases. We calculated rates of opioid prescribing at discharge from the ED and the average number of pills per opioid prescription filled. RESULTS Approximately 15-20% of ED visits resulted in opioid prescriptions filled. Rates increased from 2005 into late 2009 and 2010 and then declined steadily through 2016. Prescribing rates were similar for commercially insured and Medicaid enrollees. Being aged 25-54 years was associated with the highest rates of opioid prescriptions being filled. Hydrocodone was the most commonly prescribed opioid, but rates for hydrocodone prescription filling also fell the most. Rates for oxycodone were stable, and rates for tramadol increased. The average number of pills dispensed from prescriptions filled remained steady over the study period at 18-20. DISCUSSION Opioid prescribing rates from the ED have declined steadily since 2010 in reversal of earlier trends; however, about 15% of ED patients still received opioid prescriptions in 2016 amidst a national opioid crisis. CONCLUSIONS Efforts to reduce opioid prescribing could consider focusing on the pain types, age groups, and regions with high prescription rates identified in this study.
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Affiliation(s)
- Mir M Ali
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, 200 Independence Avenue SW, Washington D.C., 20201, USA.
| | | | - Ryan Mutter
- Health, Retirement and Long-Term Analysis Division, Congressional Budget Office, USA
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Janakiram C, Fontelo P, Huser V, Chalmers NI, Lopez Mitnik G, Brow AR, Iafolla TJ, Dye BA. Opioid Prescriptions for Acute and Chronic Pain Management Among Medicaid Beneficiaries. Am J Prev Med 2019; 57:365-373. [PMID: 31377093 PMCID: PMC6713282 DOI: 10.1016/j.amepre.2019.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Millions of Americans are affected by acute or chronic pain every year. This study investigates opioid prescription patterns for acute and chronic pain management among U.S. Medicaid patients. METHODS The study used medical and pharmacy claims data obtained from the multistate Truven MarketScan Medicaid Database from 2013 to 2015 for Medicaid patients receiving health care. Medicaid beneficiaries who utilized an outpatient healthcare facility for back pain, neck pain (cervicalgia), joint pain (osteoarthritis and rheumatoid arthritis), orthopedics (simple/closed fractures and muscle strains/sprains), headache (cluster headaches and migraines), dental conditions, or otorhinolaryngologic (otalgia) diagnoses, based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, and received an opioid prescription within 14 days of diagnosis were included in this study. RESULTS There were 5,051,288 patients with 1 of the 7 diagnostic groupings; 18.8% had an opioid prescription filled within 14 days of diagnosis. Orthopedic pain (34.8%) was the primary reason for an opioid prescription, followed by dental conditions (17.3%), back pain (14.0%), and headache (12.9%). Patients receiving an opioid for conditions associated with acute pain management, such as otorhinolaryngologic (OR=1.93, 95% CI=1.85, 2.0), dental (OR=1.50, 95% CI=1.48, 1.53), or orthopedic conditions (OR=1.31, 95% CI=1.29, 1.32), were more likely to receive the prescription from an emergency department provider versus a general practitioner. However, compared with general practitioners, other providers were more likely to prescribe opioids for conditions associated with chronic pain management. CONCLUSIONS More than half of Medicaid beneficiaries receiving an opioid for pain management do so for orthopedic- and dental-related reasons, with emergency department providers more likely to prescribe opioids. Modifications to the guidelines addressing temporary acute pain management practices with opioids would be likely to benefit emergency department providers the most.
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Affiliation(s)
- Chandrashekar Janakiram
- National Library of Medicine, Bethesda, Maryland; National Institute of Dental and Craniofacial Research, Bethesda, Maryland
| | - Paul Fontelo
- National Library of Medicine, Bethesda, Maryland
| | | | - Natalia I Chalmers
- DentaQuest Partnership for Oral Health Advancement, Boston, Massachusetts
| | | | - Avery R Brow
- DentaQuest Partnership for Oral Health Advancement, Boston, Massachusetts
| | - Timothy J Iafolla
- National Institute of Dental and Craniofacial Research, Bethesda, Maryland
| | - Bruce A Dye
- National Institute of Dental and Craniofacial Research, Bethesda, Maryland.
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Yang BK, Storr CL, Trinkoff AM, Sohn M, Idzik SK, McKinnon M. National opioid prescribing trends in emergency departments by provider type: 2005–2015. Am J Emerg Med 2019; 37:1439-1445. [DOI: 10.1016/j.ajem.2018.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022] Open
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Yorkgitis BK, Garbas B, Cole D. Opioid Prescribing Education for Physician Assistant Students: A Physician Assistant Educator Survey. J Physician Assist Educ 2019; 30:27-33. [PMID: 30720704 DOI: 10.1097/jpa.0000000000000238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The United States is facing an opioid public health crisis. Educating providers is essential for addressing this epidemic. This study sought to understand how physician assistant (PA) programs are educating students in opioid prescribing to avoid addiction. METHODS An Internet-based survey was sent to PA educators about the current landscape of opioid prescribing education (OPE) and opioid addiction education (OAE) at their institutions. RESULTS Eighty-eight completed surveys were analyzed to gauge opioid education in PA school: 49 (55.7%) educators have a mandatory OPE in their curriculum with most dedicating one hour to 3 hours (27, 55.1%) on this topic. Mandatory OAE was noted by 44 (50.0%) educators with one hour to 3 hours dedicated being the most common (24, 54.5%) amount of time. The most common method of instruction for both OPE and OAE was didactic lectures. CONCLUSIONS While some programs deliver OPE and OAE to PA students, the need exists for more programs to adopt this education.
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Affiliation(s)
- Brian K Yorkgitis
- Brian K. Yorkgitis, DO, PA-C, is an assistant professor in the Division of Acute Care Surgery at the University of Florida College of Medicine-Jacksonville, Jacksonville, Florida. Bre Garbas, DHSc, MPAS, PA-C, is an assistant professor and director of evaluation in the School of Physician Assistant Studies at the University of Florida College of Medicine, Gainesville, Florida. Debra Cole, MPAS, PA-C, is an assistant professor in the School of Physician Assistant Studies at the University of Florida College of Medicine, Gainesville, Florida
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Postoperative opioid prescribing practices and the impact of the hydrocodone schedule change. Surgery 2018; 164:879-886. [DOI: 10.1016/j.surg.2018.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/06/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
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Opioid Medication Use in the Surgical Patient: An Assessment of Prescribing Patterns and Use. J Am Coll Surg 2018; 227:203-211. [DOI: 10.1016/j.jamcollsurg.2018.04.032] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/08/2018] [Accepted: 04/23/2018] [Indexed: 01/04/2023]
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Abstract
This paper is the thirty-ninth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2016 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and CUNY Neuroscience Collaborative, Queens College, City University of New York, Flushing, NY 11367, United States.
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Osborn SR, Yu J, Williams B, Vasilyadis M, Blackmore CC. Changes in Provider Prescribing Patterns After Implementation of an Emergency Department Prescription Opioid Policy. J Emerg Med 2017; 52:538-546. [PMID: 28111065 DOI: 10.1016/j.jemermed.2016.07.120] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 01/15/2016] [Accepted: 07/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prescription opioid-associated abuse and overdose is a significant cause of morbidity and mortality in the United States. Opioid prescriptions generated from emergency departments (EDs) nationwide have increased dramatically over the past 20 years, and opioid-related overdose deaths have become an epidemic, according to the Centers for Disease Control and Prevention. OBJECTIVE Our aim was to determine the effectiveness of implementing a prescription policy for opioids on overall opioid prescribing patterns in a hospital ED. METHODS The ED provider group of an academic, non-university-affiliated urban hospital with 23,000 annual patient visits agreed to opioid prescribing guidelines for chronic pain with the goal of limiting prescriptions that may be used for abuse or diversion. These guidelines were instituted in the ED through collaborative staff meetings and educational and training sessions. We used the electronic medical record to analyze the number and type of opioid discharge prescriptions during the study period from 2006-2014, before and after the prescribing guidelines were instituted in the ED. RESULTS The number of patients discharged with a prescription for opioids decreased 39.6% (25.7% to 15.6%; absolute decrease 10.2%; 95% confidence interval [CI] 9.6-10.7; p < 0.001) after the intervention. The improvements were sustained 2.5 years after the intervention. Decreases were seen in all major opioids (hydrocodone, oxycodone, hydromorphone, and codeine). The number of pills per prescription also decreased 14.8%, from 19.5% to 16.6% (absolute decrease 2.9; 95% CI 2.6-3.1; p < 0.001). CONCLUSIONS Implementation of an ED prescription opioid policy was associated with a significant reduction in total opioid prescriptions and in the number of pills per prescription.
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Affiliation(s)
| | - Julianna Yu
- Virginia Mason Medical Center, Seattle, Washington
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Prevention of Opioid Misuse: A Summary with Suggestions from a Pain Working Group. Pain Res Manag 2016; 2016:8708654. [PMID: 27445631 PMCID: PMC4904557 DOI: 10.1155/2016/8708654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 11/20/2022]
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Choosing Analgesics Wisely: What We Know (and Still Need to Know) About Long-Term Consequences of Opioids. Ann Emerg Med 2015; 65:500-2. [DOI: 10.1016/j.annemergmed.2015.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Indexed: 11/21/2022]
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