Opioid pain medication prescriptions obtained through emergency medical visits in the Veterans Health Administration

Michael A. Grasso, MD, PhD, FACP; Zachary D. W. Dezman, MD, MS; Clare T. Grasso, PhD Candidate in Computer Science; David A. Jerrard, MD

doi:10.5055/jom.2017.0371

Authors

Michael A. Grasso, MD, PhD, FACP
Zachary D. W. Dezman, MD, MS
Clare T. Grasso, PhD Candidate in Computer Science
David A. Jerrard, MD

DOI:

https://doi.org/10.5055/jom.2017.0371

Keywords:

opioids, pain, emergency medicine

Abstract

Objective: This study sought to characterize national patterns for opioid pain medication (OPM) prescriptions received during emergency medical encounters in the Veterans Health Administration (VA).

Design: The authors conducted a retrospective study of all emergency department (ED) visits by adults in the VA between January 2009 and June 2015. We examined demographics, comorbidities, utilization measures, diagnoses, and prescriptions.

Main Outcome Measures: The percentage of ED visits that culminated in the receipt of a prescription for an OPM.

Results: There were 6,721,134 emergency medical visits by 1,708,545 individuals during the study period. An OPM was prescribed during 913,872 visits (13.6 percent), and 407,408 individuals (27.5 percent) received at least one OPM prescription. Prescriptions for OPMs peaked in 2011 at 14.5 percent, declining to 12.3 percent in 2015. The percentage of prescriptions limited to 12 pills increased from 25.0 to 32.4 percent. The heaviest users (top 1.5 percent, n = 7,247) received an average 602.5 total doses, and had at least 10 ED visits during the study period. The most frequently prescribed OPMs were acetaminophen/hydrocodone, followed by tramadol and acetaminophen/oxycodone. Receiving a prescription was associated with younger patients, musculoskeletal diagnoses, higher pain scores, a history of chronic pain, a history of mental illness, a history of substance abuse, prior heavy prescription OPM use, and lower participation in outpatient services.

Conclusions: The writing of OPM prescriptions after an ED visit is on the decline in the VA. Compliance with prescribing guidelines is increasing, but is not yet at goal.

Author Biographies

Michael A. Grasso, MD, PhD, FACP

Assistant Professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland

Zachary D. W. Dezman, MD, MS

Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland

Clare T. Grasso, PhD Candidate in Computer Science

Department of Computer Science and Electrical Engineering, University of Maryland Baltimore County, Baltimore, Maryland

David A. Jerrard, MD

Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland

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