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    Original Investigation
    Emergency Medicine
    March 25, 2020

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

    Author Affiliations
    • 1Medical Student, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
    • 2Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
    • 3Department of Statistics, Northwestern University, Evanston, Illinois
    • 4Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
    • 5Anesthesiology and Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
    JAMA Netw Open. 2020;3(3):e200802. doi:10.1001/jamanetworkopen.2020.0802
    Key Points español 中文 (chinese)

    Question  Have emergency department clinicians responded to the opioid epidemic through altering opioid prescription rates?

    Findings  In this cross-sectional study of 556 176 emergency department patient encounters and 70 218 opioid prescriptions within a single emergency department, yearly prescriptions decreased by 66.3% between 2013 and 2018. This decrease was associated with a 71.1% reduction in the number of opioid prescriptions for musculoskeletal pain (back, limb, joint, and neck pain) and lesser, but still marked, decreases for fractures and kidney stones.

    Meaning  Reductions in yearly opioid prescriptions across varying indications appear to be aligned with recognition of the opioid crisis in addition to national, state, and departmental education guidelines.


    Importance  Opioid 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 Measures  The proportion of patients prescribed an opioid for treatment of pain in the ED temporally by condition, condition type, patient demographics, and physician prescriber.

    Results  Between 2009 and 2018, 556 176 patient encounters took place in the ED, with 70 218 unique opioid prescriptions ordered. A total of 316 632 patients (55.9%) were female, 45 070 (42.6%) were of white race, and 43 412 (40.6%) were privately insured; the median age group was 41 to 45 years. Yearly opioid prescriptions decreased by 66.3% (from 16.3 to 5.5 opioids per 100 encounters) between 2013 and 2018, with a yearly adjusted odds ratio (aOR) of 0.808 (95% CI, 0.802-0.814) compared with the prior year. In patients with musculoskeletal pain (back, joint, limb, and neck pain), opioid prescribing decreased by 71.1% (from 36.7 to 10.6 opioids per 100 encounters between 2013 and 2018; aOR, 0.758; 95% CI, 0.744-0.773). In patients with musculoskeletal trauma (fracture, sprain, contusion, and injury), opioid prescribing decreased by 58.0% (from 34.2 to 14.8 opioids per 100 encounters; aOR, 0.811; 95% CI, 0.797-0.824). In patients with nonmusculoskeletal pain (abdominal pain, kidney stone, respiratory distress, and pharyngitis) opioid prescribing decreased by 53.7% (from 20.1 to 9.3 opioids per 100 encounters; aOR, 0.850; 95% CI, 0.834-0.868). Between 2009 and 2018, patients who were black (aOR, 0.760; 95% CI, 0.741-0.779) and those who were Asian (aOR, 0.714; 95% CI, 0.665-0.764) had the lowest odds of receiving an opioid compared with other racial/ethnic groups.

    Conclusions and Relevance  There was a substantial temporal decrease in the number of opioid prescriptions within this ED during the study period. This decrease was associated with substantial relative reductions in opioid prescribing for treatment of musculoskeletal pain compared with fractures and kidney stones.