Emergency department opioid prescribing trends among provider types: an analysis of the NHAMCS, 2019-2021

Despite efforts to mitigate high opioid prescription frequencies, previous research showed minimal change within emergency departments (ED) in the United States, and a few studies investigate prescription provider types. Thus, our primary objective was to assess opioid prescribing rates by differing healthcare team members using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using the 2019-2021 NHAMCS, we calculated the overall opioid prescription rate during ED visits by provider type. Next, we estimated opioid prescription rates by provider type annually and determined differences by year using design-based X² tests and regression models. From 2019 through 2021, 7428 of 50,548 visits involved opioids, representing 15.62% of all ED visits. During this timeframe, 16.59% of total encounters with opioid prescriptions were among attending/consulting physicians. This was followed by physician assistants (13.91%), nurse practitioners (10.67%), and residents (7.28%). Compared to 2019, opioid prescribing rates showed no significant changes; however, resident physicians showed a significant decrease, and RNs showed a significant increase. From our analysis, opioid prescribing rates in the ED were highest among attending/consulting physicians, and rates among physician assistants and nurse practitioners were higher than 10%. Resident physicians had a significant decrease in opioid prescriptions, while RNs had an increase-likely due to new laws enacted during this timeframe. Removing barriers to alternative pain management for acute and long-term care may lessen rates of opioid prescriptions-including patient and provider training, physical therapists inclusion, and osteopathic manipulative therapy incorporation.