Opioid Prescribing: Where Should Academic Emergency Departments Focus Their Efforts?

Opioid prescriptions from the emergency department (ED) are being heavily scrutinized. This has resulted in prescribing guidelines and laws.

We analyzed the "current state" of opioid prescribing practices by emergency medicine (EM) trainees to gain understanding where operational, educational, or supervisory efforts should be directed to comply with current guidelines and future legislation.

Our retrospective, observational, study was performed at an academic ED with an annual census of 61,289 visits. We extracted all 6962 opioid prescriptions attributed to the ED during calendar year 2015 from the electronic health record. Error prescriptions were excluded from the analysis. Overall prescribing by opioid class was performed. Prescriptions written by EM trainees were categorized by postgraduate year and compared with other prescribers. Prescribing patterns for recurrent visits were also analyzed.

Of the 6962 opioid discharge prescriptions, 5515 were written by EM providers. No refills were provided. A mean of 15.4 pills (95% confidence interval 13.9-16.9) were prescribed. Analysis of variance did not detect a significant difference between mean numbers of pills prescribed by EM providers. However, there was a significant difference between EM and non-EM prescribers. Less-experienced EM providers exhibited greater variability with regard to class and preparation. There were 389 prescriptions written for patients who received at least one other opioid prescription in the preceding 30 days. The number of pills dispensed decreased with increasing prior visits.

EM providers prescribe short courses of opiates regardless of postgraduate year. Patients returning to the ED received fewer pills on subsequent visits. Non-EM providers prescribe larger numbers of pills per prescription. This information will help focus future operational efforts and educational efforts to comply with guidelines and laws.