Decreasing Rates of Opioid Administration in the Emergency Department: Trends in National Opioid Prescribing Patterns...

Opioid prescribing in U.S. emergency departments (EDs) declined over the past decade due to policy reforms and awareness of opioids-related harm. However, the impact of the recent policies and COVID-19 on ED pain management and prescribing patterns remains unexplored.

To assess national trends in ED opioid and nonopioid analgesic use and prescribing from 2016 to 2022.

We conducted a retrospective study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We examined the proportion of visits where opioids were administered in the ED, prescribed at discharge, or both. Survey-weighted analyses compared 2016 with 2022 and included subgroup analyses by demographics, opioid type, and chief concern.

Across nearly one billion weighted ED visits, opioid administration declined from 22.4% in 2016 to 13.9% in 2022 (absolute difference: -8.5%, 95% CI -10.2 to -6.8; p < 0.001). The proportion of visits with opioids prescribed at discharge declined from 13.0% to 5.9% (absolute difference of 7.1%, 95% CI 5.6 to 8.5, p < 0.001). Nonopioid analgesic administration remained stable overall, with modest increases in select subgroups. Declines in opioid administration were observed across all demographic and hospital characteristics, though fentanyl administration increased slightly, particularly for abdominal pain.

Opioid prescribing in U.S. EDs declined significantly from 2016 to 2022. These reductions were seen across diverse patient populations and visit types, reflecting the impact of policy interventions and adoption of multimodal pain strategies. These findings highlight ongoing shifts in ED pain management and the need for continued monitoring to ensure effective pain management.