title: Impact of outside regulatory investigation on opiate administration in the emergency department.
abstract: This study was conducted to determine whether outside regulatory investigation related to opiate prescription diversion changes the prescribing frequency of opiates in an emergency department (ED). The presence of ED administration of opiates and prescriptions for opiates on discharge were compared across a baseline period 90 days before arrest of a physician for opiate diversion, a period immediately surrounding the arrest, and a follow-up period 90 days later. At no time was there investigation of excessive opiate prescribing for patients in the ED. The likelihood of receiving opiate analgesia either in the ED or on discharge was not significantly different for patients reporting mild pain or severe pain across all three periods. Patients with moderate pain (self-reported pain scores of 4 to 6 out of 10) were less likely to receive opiates in the ED immediately after the arrest compared with the baseline period (likelihood ratio, 0.4; confidence interval, 0.2 to 0.7). Patients with moderate pain were also less likely to receive prescriptions for opiates on discharge from the ED immediately after the arrest (likelihood ratio, 0.5; confidence interval, 0.3 to 0.9). These effects had diminished by 90 days.
  
  
  CONCLUSIONS
  This study indicates that factors outside of the provider-patient relationship influence the likelihood of receiving opiates during an ED visit. Awareness of this phenomenon might serve to reduce oligoanalgesia.
authors.affiliation: Department of Emergency Medicine, Albany Medical College, Albany, New York 12208, USA.
authors.forename: Mara
authors.initials: M
authors.lastname: McErlean
authors.forename: Wayne
authors.initials: W
authors.lastname: Triner
authors.forename: Amy
authors.initials: A
authors.lastname: Young
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010351:Patient Discharge; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid