Emergency Rooms Not Wholly At Fault For Opioid Crisis, Study Says

By Beth Leipholtz 01/23/18

A new study suggests that policymakers may be misguided in focusing their efforts on opioid prescribing in emergency departments. 

doctors working on patients inside of an emergency room

Contrary to popular belief, emergency departments are not the main culprit when it comes to prescribing opioids, according to a new study published in Annals of Emergency Medicine.

The research states that opioids prescribed in doctors' offices have increased 12% over a 16-year period, from 1996 to 2012, whereas such medications prescribed in emergency departments have actually decreased. 

In the same 16-year timeframe, the overall amount of opioids prescribed in the United States has increased 471%. This rise has led to an increase in the number of overdose deaths in the country as well, leading the opioid epidemic to be declared a national emergency. Because of this, state and national policies have been implemented. But often, the policies have to do with prescribing opioids in emergency departments, which this study claims is not the main source of prescriptions. 

“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 the University of Southern California, according to the American Journal of Managed Care. "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."

From 1996 to 2012, there were 15,000 patients surveyed annually to determine if they were prescribed at least one prescription opioid in that timeframe. The quantity of opioid prescriptions was then converted into milligrams of morphine. 

“To allow direct comparison across compounds, we converted prescriptions to milligrams of morphine equivalents, using conversion factors from published morphine equivalents charts,” the study stated. “We calculated the total morphine equivalents of the prescription as the prescription’s strength in milligrams multiplied by the milligrams of morphine equivalents conversion factor and the quantity of the prescription. Prescriptions lacking data on both the active ingredient and the National Drug Code were omitted from the sample.”

According to the study, 13% of the study participants filled opioid prescriptions. The study found that the majority of those who took opioids “were less well educated, less likely to live in an urban area, more likely to be from the South, more likely to be white, and more likely to have public health insurance, but less likely to be uninsured.”

The study also found that 87.8% of patients in the top 5% of opioid consumption had their prescriptions from a doctor's office, versus 2.4% from emergency departments. 

“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 [emergency department] or inpatient care,” the study read.

“The value and effect of policies directed at restricting [emergency department] 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.”

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Beth is a Minnesota girl who got sober at age 20. By day she is a website designer, and in her spare time she enjoys writing about recovery at www.lifetobecontinued.com, doing graphic design and spending time with her boyfriend and three dogs. Find Beth on LinkedInInstagram and Twitter.