Eliminating Opioid Overprescribing in EDs
How many prescribed opioid pills does it take to increase the likelihood that patients treated at emergency departments for ankle sprains will fill additional scripts for the addictive painkillers?
a. 10
b. 20
c. 30
d. 40
Answer: c
Efforts to eliminate the overprescribing of opioids should address the use of the powerful painkillers to treat relatively minor injuries in emergency departments (EDs) across the country, according to M. Kit Delgado, MD, MS, an assistant professor of emergency medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania.
Dr. Delgado’s recent study, which he presented in abstract form at the recent annual meeting of the Society for Academic Emergency Medicine, reviewed the insurance claims of more than 53,000 patients who were treated for ankle sprains in EDs and had not filled opioid prescriptions within the previous 6 months. The findings showed that 7% of patients received scripts for opioids and that prescribing practices varied significantly across states.
Patients who were prescribed 30 or more pills were twice as likely as patients who received 15 or fewer pills to fill additional opioid prescriptions within 3 to 6 months of receiving care. The substantial variation in the prescribing patterns of extremely addictive pain medications for minor injuries results in many thousands of pills entering the community and places patients at increased risk of continued use and addiction, said Dr. Delgado.
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His interest in studying ways to slow down the opioid epidemic was piqued when patients treated in his ED for heroin overdoses told him their addictions began when they were prescribed the analgesics after an injury or surgery, when resident ED doctors brought him prescriptions for 30 opioid tablets for patients with minor injuries that would have resolved with more conservative treatments, and when he noticed the prescription discharge order default for opioids in his hospital’s electronic medical record was set at 30 tablets.
He said ED providers should, whenever possible, treat opioid-naïve patients with non-opioid alternatives and dispense the lowest number of tablets possible — typically a 3-day supply or fewer than 15 tablets — to treat most painful conditions. He also advised ED pharmacists to review electronic medical record orders to ensure opioid prescribing defaults are set to dispense the safest and lowest number of tablets (10 to 15 pills, for example) during each prescription. His findings also raised another important question: Why use opioids to treat minor injuries like ankle sprains in the first place?
—Dan Cook
