Fewer Emergency Department Visits End With Opioid Prescriptions

Fewer emergency department (ED) visits end with a prescription for opioids, CDC survey data showed.

The percentage of ED visits with an opioid prescribed at discharge fell from 12.2% in 2017-2018 to 8.1% in 2019-2020, reported Loredana Santo, MD, MPH, and Susan Schappert, MA, of the National Center for Health Statistics in Hyattsville, Maryland, in NCHS Data Brief.

The rate of prescribing at discharge also dropped: in 2019-2020, opioids were prescribed at 36.4 ED visits per 1,000 adults, lower than 50.5 per 1,000 in 2017-2018. The decline was similar for both men and women.

The findings were based on the CDC’s National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual study of nonfederal, general, and short-stay hospitals. Earlier data showed that 14.6% of ED visits resulted in an opioid prescription in 2016-2017, compared with a peak of 21.5% in 2010-2011.

“This report, based on the most recent estimates from NHAMCS on ED visits made by adults with opioids prescribed at discharge, shows a continued decreasing trend in opioid prescription patterns within the ED setting,” Santo and Schappert wrote.

“Receiving an opioid prescription in the emergency department has been identified as a potential risk factor for long-term use,” they added.

Limiting opioid overprescribing in the ED may be associated with decreases in diversion and misuse, noted the authors of a 2022 meta-analysis. That analysis assessed multiple ED opioid prescribing interventions — including guidelines, prescription drug monitoring programs (PDMP), clinician peer comparison, electronic medical record quantity changes, and physical therapy — and found these programs cut prescribing rates, but not the prescribed quantity of opioids.

Other recent research suggested that, overall, ED patients consume low quantities of opioid pills and most had unused pills 10 days after their ED visit.

In the NHAMCS analysis, data for 2017-2018 were based on a sample of 3,100 ED visits with opioids prescribed at discharge, representing an estimated 12,519,000 average annual visits. Data for 2019-2020 were based on a sample of 2,015 ED visits with opioids prescribed at discharge, representing an estimated 9,132,000 average annual visits.

Opioids were defined using diagnostic codes for narcotic analgesics and narcotic analgesic combinations. Buprenorphine, buprenorphine-naloxone (Suboxone), and antitussive formulations containing opioids were not included in the study.

The researchers defined “prescribed at discharge” to include visits in which opioids were given both in the ED and prescribed at discharge, or prescribed at discharge only. Visits in which opioids were given in the ED only were excluded.

In 2019-2020, opioids were prescribed at discharge at 17.1 visits per 1,000 adults, and opioids were both given in the ED and prescribed at discharge at 19.3 visits, totaling 36.4 visits. In contrast, in 2017-2018, opioids were prescribed at discharge at 24.3 visits, and opioids were both given in the ED and prescribed at discharge at 26.2 visits, totaling 50.5 visits.

The percentage of ED visits with an opioid prescribed at discharge was similar across all race and ethnicity groups for 2019-2020 and 2017-2018. Declines in prescribing occurred across all primary expected sources of payment.

In 2019-2020, the percentage of ED visits with opioids prescribed at discharge was higher for visits with private insurance (9.4%) compared with Medicare visits (7.1%). Percentages were similar for Medicaid visits (8.4%) and visits with no insurance (8.5%).