Study challenges notion that emergency departments foster opioid misuse

A new study from the Annals of Emergency Medicine suggests emergency physicians are not the free-flowing source for opioids they were previously thought to be.

A team of researchers examined 5.2 million opioid prescriptions and found that in the ED opioid prescriptions exceeding seven days were 84 to 91 percent lower than in non-emergency settings, depending on insurance status.

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The potency and dosage size for opioids coming out of the ED as documented in the research also suggests there are bigger offenders. Prescriptions from the ED were 33 to 54 percent less likely to exceed 90 milligram equivalents, which is considered a high dose, and 23 to 37 percent less likely to exceed 50 morphine milligram equivalents. Also, ED opioid prescriptions were 86 to 92 percent less likely to be written for long-acting or extended-release formulations than those from non-emergency settings, researchers said.

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What's more, results also indicated that patients who are prescribed opioids for the first time in the ER are less likely to become users, regardless of insurance coverage. Patients with commercial insurance were 46 percent less likely to progress to long-term opioid use, Medicare patients age 65 and older were 56 percent less likely and patients with disabled Medicare were 58 percent less likely to end up long-term users if they were prescribed opioids in the ED, the study said.

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"Over time, prescriptions written in the ER for high dose opioids decreased between 2009 and 2011," said Ms. Jeffery. "Less than 5 percent of opioid prescriptions from the ER exceeded 7 days, which is much lower than the percentage in non-emergency settings. Further research should explore how we can replicate the success of opioid prescribing in emergency departments in other medical settings."

One hospital in Minnesota is already hard at work on such an initiative. CHI St. Gabriel's, which serves Morrison County, has helped 324 patients get off controlled substances completely. In a year, that means more than 370,000 fewer controlled substance doses flowing into the community, according to the Minnesota Hospital Association.

Before the program, pain was the major cause for patient ED visits, and in most cases it was treated with narcotic medication. In a given month, just one of the community's four pharmacies filled an average of 48,000 controlled substance doses, the association said in a statement.

CHI St. Gabriel's works with law enforcement, medical professionals and public health advocates in the community, as well as other leaders, to prioritize opioid misuse, ensure that chronic pain patients are treated with the safest medications and those with substance abuse issues get medical treatment instead of landing in jail.

The hospital created a "Controlled Substance Care Team" program to monitor patients on chronic pain medications and decide when medication is appropriate. If the team suspects misuse, they provide resources to treat the patient's use disorder.

The Controlled Substance Care Team's have decreased the number of pills filtering into the community for potential misuse, and in its first eight months, pain no longer even ranked in the top 20 reasons for ED visits. Also, one of the community's four pharmacies reported a 23 percent decrease in controlled substance prescriptions, the association said.

"I believe that this program is scalable," said Kurt Devine, MD, a CHI St. Gabriel's physician who co-leads the team, "I think the reality is, with the right funding so we can have the right people in clinics helping these patients, this can work in other communities."

Twitter: @BethJSanborn
Email the writer: beth.sandborn@himssmedia.com