Emergency Department Contribution to the Prescription Opioid Epidemic

We characterize the relative contribution of emergency departments (EDs) to national opioid prescribing, estimate trends in opioid prescribing by site of care (ED, office-based, and inpatient), and examine whether higher-risk opioid users receive a disproportionate quantity of their opioids from ED settings.

This was a retrospective analysis of the nationally representative Medical Expenditure Panel Survey from 1996 to 2012. Individuals younger than 18 years and with malignancy diagnoses were excluded. All prescriptions were standardized through conversion to milligrams of morphine equivalents. Reported estimates are adjusted with multivariable regression analysis.

From 1996 to 2012, 47,081 patient-years (survey-weighted population of 483,654,902 patient-years) surveyed by the Medical Expenditure Panel Survey received at least 1 opioid prescription. During the same period, we observed a 471% increase in the total quantity of opioids (measured by total milligrams of morphine equivalents) prescribed in the United States. The proportion of opioids from office-based prescriptions was high and increased throughout the study period (71% of the total in 1996 to 83% in 2012). The amount of opioids originating from the ED was modest and declined throughout the study period (7.4% in 1996 versus 4.4% in 2012). For people in the top 5% of opioid consumption, ED prescriptions accounted for only 2.4% of their total milligrams of morphine equivalents compared with 87.8% from office visits.

Between 1996 and 2012, opioid prescribing for noncancer patients in the United States significantly increased. The majority of this growth was attributable to office visits and refills of previously prescribed opioids. The relative contribution of EDs to the prescription opioid problem was modest and declining. Thus, further efforts to reduce the quantity of opioids prescribed may have limited effect in the ED and should focus on office-based settings. EDs could instead focus on developing and disseminating tools to help providers identify high-risk individuals and refer them to treatment.