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Emergency Room Opioid Prescriptions Jump in 2001-2010

Prescription drugs


14 March 2014. Medical researchers at George Washington University in Washington, D.C. found large increases in prescriptions for opioid pain-killers in U.S. hospital emergency rooms over the 2001-2010 decade. The team led by emergency medicine faculty Maryann Mazer-Amirshahi published its findings online yesterday in the journal Academic Emergency Medicine (paid subscription required).

Mazer-Amirshahi and colleagues analyzed data collected in the National Hospital Ambulatory Medical Care Survey collected from 2001 through 2010, extracting responses where emergency departments prescribed pain-killers. The survey gathers  information on provision and use of ambulatory medical care services in the United States, from a national sample of visits to emergency and outpatient departments at general and short-stay hospitals.

From survey records with pain-killer prescriptions, the team compiled trends in use of six commonly prescribed opioids, as well as nonopioid pain-killers. Frequency of pain-related emergency room visits were also calculated, as well as time of opioid prescription — during the stay in the hospital or at discharge — for the years 2005 to 2010.

The researchers found overall emergency visits where an opioid analgesic was prescribed increased 10 percentage points, from 21 to 31 percent over the decade. During that same period, however, emergency room visits due to painful conditions rose only 4 points, from 47 percent in 2001 to 51 percent in 2010.

The percentage of pain-killers on DEA’s list of Schedule II controlled substances — those with potential for abuse that may lead to severe psychological or physical dependence — rose 7 points by 2010, from 8 to 15 percent, nearly doubling the rate at the start of the decade. Prescriptions for hydrocodone, hydromorphone, morphine, and oxycodone all had statistically reliable increases over the period, where the changes are greater than those likely due to normal variation.

Dilaudid, a hydromorphone pain-killer on DEA’s Schedule II, had the highest rate of increase from 2001 to 2010, jumping 668 percent in emergency room prescriptions over the decade. The drug is prescribed for severe pain, but has a high risk of abuse and severe adverse effects, particularly breathing problems. The street name for diluadid, according to Urban Dictionary, is “hospital heroin.”

Researchers found no change in the rate of prescriptions for nonopioid pain-killers, from 26 percent in 2001 to 27 percent in 2010. Prescriptions for codeine and meperidine declined over the decade.

Mazer-Amirshahi and colleagues reported increases in opioid prescriptions across all age groups and types of payers (e.g. insurance, Medicare), as well as for both white and black Americans. However black Americans were consistently prescribed fewer opioids than whites. Western states had the highest rates of opioid prescriptions, while northeastern states had the lowest prescription rates. Midwestern states had the largest proportional increases in opioid prescriptions.

“More needs to be done to monitor opioid prescriptions in emergency departments,” says Mazer-Amirshahi in a university statement. “Having recommended standard approaches may be a good starting point.”

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