Emergency Department Prescribing and Opioid-Related Harms Among Adolescents in Alberta: 2010-2020

Although emergency department (ED) prescribing is targeted as a potential contributor to opioid-related harms, the impact of efforts to curb prescribing and subsequent harms are poorly understood. We examined how rates of ED opioid prescribing and subsequent opioid-related harms have changed over time among adolescents.

We conducted a cohort study using linked administrative data sets of patients aged 12 to 17 years who were discharged from any ED in Alberta, Canada, from April 1, 2010, to June 30, 2020. Opioid prescription fills in the 3 days after an ED visit were included. Our primary outcome was the development of opioid-related harms: a 1-year composite of opioid-related ED visit, opioid-related hospitalization, and opioid agonist therapy prescription. Joinpoint regression was used to identify changes in rates.

Among 1 197 829 ED visits, ED opioid prescribing decreased from 3.3% of visits in 2010 to 1.2% in 2020; specifically, codeine and oxycodone prescribing decreased while tramadol and other opioid prescribing increased. General EDs prescribed more opioids than pediatric EDs (2.5% vs 1.5%) and saw slower decreases over time. The development of opioid-related harms increased from 0.15% in 2010 to 0.28% in 2020.

During a decade when ED opioid prescribing to adolescents decreased substantially, subsequent opioid-related harms nearly doubled in Alberta. Broad deprescribing measures in the ED may not effectively combat the opioid epidemic in this province. However, caution should remain for patients with longer prescription durations, frequent ED use, and mental health or substance use comorbidity and further studies are needed to better delineate patient-level risk.