Pain Management of Minor Injuries in the ED

In which state are emergency department providers most likely to prescribe opioids to manage the pain of patients who suffered relatively minor injuries?

a. Pennsylvania

b. Arkansas

c. Texas

d. North Dakota

Answer: b

Patients who limp into emergency departments with sprained ankles in Arkansas are more likely to hobble out with scripts for opioids, according to researchers at Penn Medicine. Their review of 30,800 patients who visit EDs across the country for treatment of ankle sprains—chosen because the injury shouldn’t be treated with opioids—revealed 25% of the patients received opioids.

Opioid use was highest in Alabama (40%) and lowest in North Dakota (3%).  The troubling findings also reveal opportunities for needed improvement in opioid use. If prescribing rates in high-use states were more in line with the average (25%), 18,000 fewer opioids would be given to patients and limiting the number of pills to 16 would mean 32,000 fewer pills would be given out.

So what can be done to ensure opioid are used more judiciously in EDs? Study co-author Kit Delgado, MD, an assistant professor of emergency medicine and epidemiology at Penn Medicine in Philadelphia, said providers need to take advantage of non-opioid therapies for minor injuries, prescribe the lowest possible dose, dole out no more than 10 pills at a time if opioids are in fact needed, and reassess patients’ ability to manage pain to determine if larger courses are necessary. Dr. Delgado said national and state guidelines recommend limited opioid prescriptions in the ED for acute pain to a 3-day supply and that changing default settings in electronic orders is an effective and easy way to ensure patients don’t leave with more pain meds than they need.

—Dan Cook

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