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Trends in and predictors of hydromorphone administration in US emergency departments (2007-2014)

Maryann Mazer-Amirshahi, PharmD, MD, MPH, Diana Ladkany, MD, Peter M. Mullins, MA, MPH, Sergey Motov, MD, Jeanmarie Perrone, MD, Lewis S. Nelson, MD, Jesse M. Pines, MD, MBA, MSCE


Objective: To examine recent trends in and predictors of hydromorphone administration in US emergency departments (EDs) compared with other opioids.

Design: Retrospective review of data from the National Hospital Ambulatory Medical Care Survey from 2007 to 2014.

Participants: All adult ED visits where an opioid analgesic was administered were included.

Main outcome measures: Trends in and predictors of hydromorphone administration were assessed using survey-weighted logistic regression, comparing hydromorphone visits with ED visits where other opioids were administered.

Results: From 2007 to 2014, in an estimated 128.9 million US ED visits where opioids were administered, hydromorphone use increased significantly from 30.2 percent in 2007 to 36.8 percent of visits in 2014 (p = 0.027). Hydromorphone accounted for a greater proportion of opioids administered by the end of the study period, compared to other opioids. Patient characteristics associated with hydromorphone were age <65 years, white race, private insurance or Medicare, and severe pain. Patients who received hydromorphone also had indicators of higher severity illness, including more laboratory testing, procedures, and higher admission rates. Common conditions where hydromorphone was administered were headache, back pain, musculoskeletal pain, and abdominal pain.

Conclusion: From 2007 to 2014, hydromorphone was administered to more than one in three US ED patients who were administered opioids, and several factors predicted its use. High use was found in some conditions where opioid use is inappropriate, suggesting a need for additional initiatives to promote rational prescribing of high-potency opioids.


hydromorphone, administration, emergency department

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