Emergency Department Patients Prescribed More Opioids Than They Used

AHRQ-funded research has found significant overprescribing of an opioid in an emergency setting. The study, published in Pain Medicine, found that nearly 93 percent of patients who were prescribed hydrocodone-acetaminophen after visiting the emergency department (ED) consumed far fewer pills than they were given. Researchers reviewed 10-day medication diaries completed by 260 patients who were prescribed the opioid at the ED, and found that while patients were prescribed an average of 12 pills, all (with the exception of those with back pain) used fewer than 12 on average. Patients with renal colic consumed the least, averaging only three pills used after 10 days. Access the abstract.

Patient-Reported Opioid Pill Consumption After an ED Visit: How Many Pills Are People Using?

Affiliations

PMID: 32219431
DOI: 10.1093/pm/pnaa048

Abstract

Objectives: Recent guidelines advise limiting opioid prescriptions for acute pain to a three-day supply; however, scant literature quantifies opioid use patterns after an emergency department (ED) visit. We sought to describe opioid consumption patterns after an ED visit for acute pain.

Design: Descriptive study with data derived from a larger interventional study promoting safe opioid use after ED discharge.

Setting: Urban academic emergency department (>88,000 annual visits).

Subjects: Patients were eligible if age >17 years, not chronically using opioids, and newly prescribed hydrocodone-acetaminophen and were included in the analysis if they returned the completed 10-day medication diary.

Methods: Patient demographics and opioid consumption are reported. Opioid use is described in daily number of pills and daily morphine milligram equivalents (MME) both for the sample overall and by diagnosis.

Results: Two hundred sixty patients returned completed medication diaries (45 [17%] back pain, 52 [20%] renal colic, 54 [21%] fracture/dislocation, 40 [15%] musculoskeletal injury [nonfracture], and 69 [27%] "other"). The mean age (SD) was 45 (15) years, and 59% of the sample was female. A median of 12 pills were prescribed. Patients with renal colic used the least opioids (total pills: median [interquartile range {IQR}] = 3 [1-7]; total MME: median [IQR] = 20 [10-50]); patients with back pain used the most (total pills: median [IQR] = 12 [7-16]; total MME: median [IQR] = 65 [47.5-100]); 92.5% of patients had leftover pills.

Conclusions: In this sample, pill consumption varied by illness category; however, overall, patients were consuming low quantities of pills, and the majority had unused pills 10 days after their ED visit.

Keywords: Emergency Department; Opioid; Pain Management.