Long Term Opioid Use Contributed To By Liberal Prescribing Emergency Department Physicians

A recent article in the New England Journal of Medicine underscored two significant problems with opioid medications.  The first was there is a wide variance in how emergency medicine doctors prescribed opioid medications.  Looking at the same hospitals, doctors prescribed narcotic pain medications anywhere from 7.3% to 24.1% of patients they saw.  This means that some doctors rarely prescribed narcotics, while other frequently (almost triple) gave their patients these medications.

The study underscored that this wide variance occurred because, until recently, there was little objective guidance on how to prescribe these potentially dangerous medications.  Most other medications come with strict, evidence based guidelines on when and how they are to be prescribed.  Opioid prescribing, however, was largely left to the unfettered judgement of the doctor, with little guidance to follow.  As a result, there was very little uniformity on who and how patients would receive these doctors. 

Second, this study documented that some patients become addicted to pain medications after a single prescription from an emergency department.  The study evaluated that of 48 patients that receive opioids for the first time in the ED, 1 will become a long term user.  One explanation for this is that once the “inertia” for an opioid prescription is put in motion, subsequent physicians are more likely to renew a prescription for the medication. 

The conclusion of the study stated:

In conclusion, we found variation by a factor of more than three in rates of opioid prescribing by emergency physicians within the same hospital and increased rates of long-term opioid use among patients treated by high-intensity opioid prescribers. These results suggest that an increased likelihood of receiving an opioid for even one encounter could drive clinically significant future long-term opioid use and potentially increased adverse outcomes among the elderly. Future research may explore whether this variation reflects over prescription by some prescribers and whether it is amenable to intervention.