By Pat Anson, Editor
Patients who are prescribed opioid pain medication for the first time in hospital emergency rooms are less likely to become long term opioid users than patients in other settings, according to a large new study by researchers at the Mayo Clinic.
"Our paper lays to rest the notion that emergency physicians are handing out opioids like candy," said lead author Molly Moore Jeffery, PhD, scientific director of the Mayo Clinic Division of Emergency Medicine Research. “Most opioid prescriptions written in the emergency department are for shorter duration, written for lower daily doses and less likely to be for long-acting formulations."
Jeffrey and her colleagues analyzed data for 5.2 million opioid prescriptions filled in emergency rooms from 2009 to 2015.
They found that only 1.1% percent of “opioid naïve” patients with private insurance progressed to long term opioid use. That compares to 2% of patients in non-emergency settings. Long term use was defined as someone getting 10 or more refills or more than a 120 day supply of opioids in a year.
About 3 percent of Medicare beneficiaries used opioids long term after getting them in an ER, with disabled Medicare patients the most likely ER patients to progress to long term use (13.4%).
Only 3.3% of opioid doses for privately insured patients in the ER exceeded 90mg morphine equivalent units (what the CDC considers a high daily dose). That compares to 7.2% of doses in non-emergency settings. The duration of prescriptions was also lower for ER patients.
"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," said Jeffery, whose study is published online in the Annals of Emergency Medicine.
The use of opioid medication in hospital emergency rooms has become a contentious issue for both patients and physicians, with many patients complaining that they are profiled and labeled as drug seekers when they seek treatment at an ER for pain.
“I refuse to go to the ER for pain. Unless I feel I'm absolutely dying, I will not go. It isn't worth being made to feel like I'm only ‘putting on a show’ or I'm a junkie just trying to get high,” one pain sufferer told us.
In a survey of over 1,250 pain patients last year by PNN and the International Pain Foundation, 80 percent said they had felt labeled as an addict or drug seeker by hospital staff. Asked if doctors were reluctant to prescribe opioid medication while they were hospitalized, over two-thirds said it happens often or sometimes. To see the complete survey results, click here.
“I had a doctor in an emergency room situation one time during an episode I was having, who actually stood in the open doorway of my room, I was still in the ER, and yelled at me as loud as he could, that he wasn't giving me any pain medicine,” said one patient.
Some hospitals, such as Temple University Hospital in Philadelphia, have adopted guidelines that discourage opioid prescribing to ER patients. The voluntary policy quickly won broad support from Temple’s physicians.
In a survey by the hospital, only 13% of Temple’s ER doctors thought patients with legitimate reasons for opioids were denied appropriate care. A large majority – 84% of the doctors -- did not believe patients were denied appropriate pain relief.
“Emergency physicians have identified themselves as targets for patients who seek opioids for nonmedical purposes, yet it can be difficult for clinicians to distinguish drug seeking behavior from legitimate need,” said Daniel del Portal, MD, Assistant Professor of Clinical Emergency Medicine at the Lewis Katz School of Medicine at Temple University.