title: Opioid Prescribing in a Cross Section of US Emergency Departments.
abstract: OBJECTIVE
  Opioid pain reliever prescribing at emergency department (ED) discharge has increased in the past decade but specific prescription details are lacking. Previous ED opioid pain reliever prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study is to use a research consortium to analyze the characteristics of patients and opioid prescriptions, using a national sample of ED patients. We also aim to examine the indications for opioid pain reliever prescribing, characteristics of opioids prescribed both in the ED and at discharge, and characteristics of patients who received opioid pain relievers compared with those who did not.
  
  
  METHODS
  This observational, multicenter, retrospective, cohort study assessed opioid pain reliever prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18 to 90 years and discharged with an opioid pain reliever (excluding tramadol) were individually abstracted by standardized chart review by investigators for detailed analysis. Descriptive statistics were generated.
  
  
  RESULTS
  During the study week, 27,516 patient visits were evaluated in the consortium EDs; 19,321 patients (70.2%) were discharged and 3,284 (11.9% of all patients and 17.0% of discharged patients) received an opioid pain reliever prescription. For patients prescribed an opioid pain reliever, mean age was 41 years (SD 14 years) and 1,694 (51.6%) were women. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with opioid pain reliever prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common opioid pain relievers prescribed were oxycodone (52.3%), hydrocodone (40.9%), and codeine (4.8%). Greater than 99% of pain relievers were immediate release and 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (interquartile range 12 to 20), respectively.
  
  
  CONCLUSIONS
  In a study of ED patients treated during a single week across the country, 17% of discharged patients were prescribed opioid pain relievers. The majority of the prescriptions had small pill counts and almost exclusively immediate-release formulations.
authors.affiliation: Department of Emergency Medicine, University of Colorado, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Hoppe
authors.affiliation: Department of Emergency Medicine, New York University School of Medicine, New York, NY.
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeanmarie
authors.initials: J
authors.lastname: Perrone
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: sgweiner@partners.org.
authors.forename: Scott G
authors.initials: SG
authors.lastname: Weiner
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy; D003061:Codeine / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000188:drug therapy; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006853:Hydrocodone; D010098:Oxycodone; D003061:Codeine