Case Management

Study focuses in on ED opioid prescribing practices

Case Management Insider, July 14, 2015

A study by researchers at Brigham and Women’s Hospital (BWH) in Boston provides new information about how opioid medications are typically prescribed in emergency departments (ED) across the nation. Study authors hope this new information will enable policy-makers to better target interventions to prevent abuse and inappropriate prescribing in the future.

Case managers in the ED often face challenges with patients who have drug-seeking behavior. Some patients will “shop” EDs in hopes of securing pain medication, says Karen Zander, RN, MS, CMAC, FAAN, president and owner of The Center for Case Management in Wellesley, Massachusetts. Zander spoke during the February 25 HCPro webcast, “Emergency Department Case Management: Manage Challenging Patients and Special Populations.”

Some have questioned whether improper prescribing practices are contributing to the problem. However, authors for the BWH study, which was published online in Annals of Emergency Medicine, found that doctors are often doing the right thing when it comes to opioids. In most cases, they’re not prescribing patients the type of opioids that are most likely to lead to overdoses and often only prescribe a limited quantity of the medication.

“Our data show that opioid prescribing in the ED is done with caution and aligned with short-term use goals. The median number of pills per prescription was 15, and only 1.5% of prescriptions were for more than 30 pills, suggesting that emergency physicians generally follow guideline recommendations to limit opioid prescriptions to only three to five days, and avoid long-acting opioids,” said Scott G. Weiner, MD, MPH, corresponding author of the study and emergency physician at BWH.

Study findings were based on samples from 19 EDs across the nation during a single week in October 2012. Researchers looked at why opioids were prescribed, what type was given, who doctors were prescribing the medication to, and compared patients who were prescribed opioids to patients who were not.

In total, researchers analyzed 27,516 patient visits. Nearly 12% of patients left the hospital with a prescription opioid. Most often these medications were given to patients suffering from back or abdominal pain, followed by fractures and sprains, and dental problems. The two most prescribed opioid pain relievers were oxycodone and hydrocodone.

The study findings can be used to develop future initiatives to curb medication abuse.

“We hope that this study will add to the literature and inform policy-makers about the actual scope of ED opioid prescribing, so that efforts to address addiction and reduce inappropriate prescribing can be accurately focused,” Weiner said.

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