Study Shows Emergency Departments Are Not to Blame for American Opioid Epidemic

While emergency departments (EDs) are often blamed as the culprit of allotting excessive amounts of opioids to patients, office-based opioid prescriptions have increased 12% from 1996 to 2012 while ED use of opioids have decreased, according to a study published in Annals of Emergency Medicine.

The quantity of opioids prescribed in the United States has increased 471%, resulting in an increase of deaths by overdose which has created a national crisis. Politicians—like former Republican New Jersey Governor Chris Christie—and other public figures have made it their priority to bring awareness to the opioid addiction issue. Policies have been passed on the state and federal level to reduce opioid misuse, often targeting ED prescriptions, despite the unknown impact ED opioid prescribing has on the epidemic.

“Policy makers and providers should match interventions with settings where they are most likely to be successful” said lead study author Sarah Axeen, PhD, assistant professor of emergency medicine at the Keck School of Medicine at University of Southern California. "Efforts to reduce the quantity of opioid prescriptions should focus less on hospital-based prescribing and more on doctor’s office-based prescribing practices, specifically addressing refills, or chronic prescriptions."

The Medical Expenditure Panel Survey from 1996 to 2012 was analyzed to determine trends in office-based and emergency department prescribing. The authors evaluated the contribution of EDs to the national level of opioid prescribing compared to other sites offering care and identified the main source of opioid prescription in the top 5% of prescription opioid consumption.

The survey included approximately 15,000 patients annually and analyzed if individuals obtained at least one prescription opioid during the 15-year period. The quantity of opioid prescriptions was converted into milligrams of morphine. The demographics of patients who were prescribed opioids were also taken into consideration by the researchers.

The data show that from 1996 to 2012, 13% of all participants filled opioid prescriptions. Most patients who took opioids were less educated, lived in rural areas in the South, were most likely white, and were more likely to have public health insurance. Patients in the top 5% of opioid consumption had 87.8% of their opioids from office prescriptions while only 2.4% were from ED prescriptions.

It was also recorded that most patients did not receive their prescriptions from EDs, rather from other healthcare sites. 44% of opioids were derived from office-based prescriptions, 26% from dental or other outpatient sources, 16% from emergency departments, and 14% from inpatient settings.

“We found that the explosive increase in prescription opioids in the United States has been largely driven from refilled or chronic prescriptions from office-based practice and not from ED or inpatient care,” the authors concluded. “The value and effect of policies directed at restricting ED prescriptions of opioids should be reevaluated in light of these findings. Policies aiming at reducing the quantity of opioids prescribed should generally focus on office-based prescriptions and specifically target reducing the amount of repeated or chronic prescriptions and focus less on hospital-based efforts.”