Opioid pain medication prescriptions obtained through emergency medical visits in the Veterans Health Administration
Keywords:opioids, pain, emergency medicine
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.
Dart RC, Surratt HL, Cicero TJ, et al: Trends in opioid analgesic abuse and mortality in the United States. N E J Med. 2015; 372(3): 241-248.
Poon SJ, Greenwood-Ericksen MB: The opioid prescription epidemic and the role of emergency medicine. Ann Emerg Med. 2014; 64(5): 490-495.
CDC: Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics, 2016. Available at http://wonder.cdc.gov. Accessed July 28, 2016.
Marks RM, Sachar EJ: Under-treatment of medical inpatients with narcotic analgesics. Ann Intern Med. 1973; 78: 173-181.
Donovan M, Dillon P, McGuire L: Incidence and characteristics of pain in a sample of medical-surgical inpatients. Pain. 1987; 30: 69-78.
Sriwatanakul K, Weis OF, Alloza JL, et al: Analysis of narcotic analgesic usage in the treatment of postoperative pain. JAMA. 1983; 250: 926-929.
Portenoy RK, Foley KM: Chronic use of opioid analgesics in non-malignant pain: Report of 38 cases. Pain. 1986; 25: 171-186.
Berry PH, Dahl JL: The new JCAHO pain standards: Implications for pain management nurses. Pain Manag Nurs. 2000; 1: 3-12.
Stempniak M: Doctors urge CMS, Joint Commission to rethink pain treatment to help stem opioid epidemic. Hospitals & Health Networks. Available at http://www.hhnmag.com/articles/7164-doctors-urge-cms-joint-commission-to-rethink-pain-treatmentto-help-stem-opioid-epidemic. Accessed July 28, 2016.
Veterans Health Administration: National Pain Management Strategy, November 12, 1998. Available at http://www.va.gov/PAINMANAGEMENT/VHA_Pain_Management_Strategy.asp. Accessed July 28, 2016.
Max MB, Donovan M, Miaskowski CA, et al: Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA. 1995; 274: 1874-1880.
American Pain Society: Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 4th Ed. Glenview, IL: American Pain Society, 1999.
Volkow ND: America's addiction to opioids: Heroin and prescription drug abuse. National Institute on Drug Abuse, May 14, 2014. Available at www.drugabuse.gov/about-nida/legislativeactivities/testimony-to-congress/2015/americas-addiction-toopioids-heroin-prescription-drug-abuse. Accessed July 28, 2016.
Wang J, Christo PJ: The influence of prescription monitoring programs on chronic pain management. Pain Physician. 2009; 12: 507-515.
Substance Abuse and Mental Health Services Administration: Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
Cheng D, Majlesi N: Emergency Department Opioid Prescribing Guidelines for the Treatment of Non-Cancer Related Pain. American Academy of Emergency Medicine, November 12, 2013. Available at www.aaem.org/UserFiles/file/Emergency-Department-Opoid-Prescribing-Guidelines.pdf. Accessed July 28, 2016.
Cantrill SV, Brown MD, Carlisle RJ, et al: Clinical policy: Critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012; 60(4): 499-525.
Ducharme J, Ducharme J: Proceedings from the first international symposium on pain research in emergency medicine: Foreword. Ann Emerg Med. 1996; 27: 399-403.
Ducharme J, Barber C: A prospective blinded study on emergency pain assessment and therapy. J Emerg Med. 1995; 13: 571-575.
Cordell WH, Keene KK, Giles BK, et al: The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002; 20: 165-169.
Tanabe P, Buschmann M: A prospective study of ED pain management practices and the patient's perspective. J Emerg Nurs. 1999; 25: 171-177.
Mazer-Amirshahi M, Mullins PM, Rasooly I, et al: Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010. Acad Emerg Med. 2014; 21: 236-243.
Hoppe JA, Nelson LS, Perrone J, et al: Opioid prescribing in a cross section of US emergency departments. Ann Emerg Med. 2015; 66: 253-259.
Maryland Hospital Association: Maryland Emergency Department Opioid Prescribing Guidelines. Available at www.mhaonline.org/docs/default-source/Resources/Opioid-Resources-for-Hospitals/maryland-emergency-department-opioid-prescribing-guidelines.pdf?sfvrsn=2. Accessed July 28, 2016.
Klauer K, Bukata R: NYC limits ED opioid prescriptions. Emergency Physicians Monthly, February 2013. Available at http://epmonthly.com/article/nyc-limits-ed-opioid-prescriptions/. Accessed July 28, 2016.
Ramsey J: New opioid prescription guidelines offered to Va. ER docs. Richmond Times Dispatch. Available at http://www.richmond.com/business/article_14ccbd98-19ac-56ae-8223-81b5013ef5f8.html. Accessed July 28, 2016.
United States Department of Veterans Affairs: National Center for Veterans Analysis and Statistics. October 9, 2015. Available at www.va.gov/vetdata/. Accessed July 28, 2016.
Health Services Research & Development, United States Department of Veterans Affairs: VA Informatics and Computing Infrastructure (VINCI). Available at www.hsrd.research.va.gov/for_researchers/vinci/. Accessed July 28, 2016.
Sharabiani MT, Aylin P, Bottle A: Systematic review of comorbidity indices for administrative data. Med Care. 2012; 50: 1109-1118.
Kirschner N, Ginsburg J, Sulmasy LS, et al: Prescription drug abuse: Executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2014; 160(3): 198-200.
Rosenblum A, Marsch LA, Joseph H, et al: Opioids and the treatment of chronic pain: Controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008; 16(5): 405-416.
CDC: Prescription opioid overdose data. Atlanta, GA: CDC, National Center for Health Statistics, 2016. Available at http://www.cdc.gov/drugoverdose/data/overdose.html. Accessed July 28, 2016.
Westanmo A, Marshall P, Jones E, et al: Opioid dose reduction in a VA health care system--implementation of a primary care population-level initiative. Pain Med. 2015; 16(5): 1019-1026.
Dorflinger L, Moore B, Goulet J, et al: A partnered approach to opioid management, guideline concordant care and the stepped care model of pain management. J Gen Intern Med. 2014; 29(suppl 4): 870-876.
Grasso MA, Dezman ZD, Comer AC, et al: The decline in hydrocodone/acetaminophen prescriptions in emergency departments in the Veterans Health Administration between 2009 to 2015. West J Emerg Med. 2016; 17(4): 396-403.
Kolodny A, Courtwright DT, Hwang CS, et al: The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annu Rev Public Health. 2015; 36: 559-574.
Han B, Compton WM, Jones CM, et al: Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003-2013. JAMA. 2015; 314(14): 1468-1478.
Langås AM, Malt UF, Opjordsmoen S: Comorbid mental disorders in substance users from a single catchment area—a clinical study. BMC Psychiatry. 2011; 11: 25.
Murthy P, Chand P: Treatment of dual diagnosis disorders. Curr Opin Psychiatry. 2012; 25(3): 194-200.
Agha Z, Lofgren RP, VanRuiswyk JV, et al: Are patients at veterans affairs medical centers sicker? A comparative analysis of health status and medical resource use. Arch Intern Med. 2000; 160(21): 3252-3257.
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