ED Patients of Frequent Opioid Prescribers Often Become Long-Term Users

Long-term opioid painkiller use appears more common among emergency department (ED) patients treated by physicians with higher opioid prescription rates, according to recent research  in the New England Journal of Medicine. 

“It is commonly thought that opioid dependence often begins through an initial, possibly chance, exposure to a physician-prescribed opioid, although data from studies to empirically evaluate this claim are lacking,” Michael L Barnett, MD, assistant professor at the Harvard T.H. Chan School of Public Health, and colleagues wrote. “Our results provide evidence that this mechanism could drive initiation of long-term opioid use through either increased rates of opioid prescription or prescription of a high, versus a low, dose of opioid.”

The researchers collected and reviewed a sample of Medicare beneficiaries who visited an ED between 2008 and 2011.

Within single hospitals, Dr Barnett and colleagues found varying opioid prescription rates between the low-intensity and high-intensity prescriber groups (7.3% vs 24.1%; P < .001). This trend was similar across all patient subgroups, although the researchers observed the highest average rate of long-term use among patients visiting the ED with an injury.

Across the entire study, long-term opioid use at 12 months was more frequent among those treated by high-intensity prescribers before and after adjustment (1.51% vs 1.16; aOR = 1.3; 95% CI, 1.24-1.37). Additional examination found increased odds of long-term opioid use dependent on the strength of the dosage. 

“These results suggest that an increased likelihood of receiving an opioid for even one encounter could drive clinically significant future long-term opioid use,” the researchers wrote. —Dave Muoio