title: Non-medical use of prescription pain medications and increased emergency department utilization: Results of a national survey.
abstract: BACKGROUND
  There are no population-based studies of emergency department (ED) utilization by individuals using prescription pain medications non-medically. We examined whether non-medical use of prescription pain medications was independently associated with increased ED utilization.
  
  
  METHODS
  We conducted a retrospective analysis of a nationally representative sample of the non-institutionalized, civilian U.S. population in the National Survey on Drug Use and Health, 2008-2013. We used multivariable logistic regression to examine the association between past year ED utilization and non-medical use of prescription pain medications, defined as use of medications "not prescribed for you or that you took only for the experience or feeling they caused".
  
  
  RESULTS
  An estimated 10.5 million adults annually reported past year non-medical use (NMU) of prescription pain medications, and 39%, or 4.1 million adults annually, also reported one or more past year ED visits. After adjustment for sociodemographic and clinical characteristics, adults with past year NMU of prescription pain medications had increased odds of past year ED utilization (adjusted odds ratio 1.32; 95% confidence interval 1.24-1.41). In secondary analyses, individuals with more frequent NMU had increased odds of ED utilization in unadjusted analyses, but this association was attenuated with adjustment for the source of prescription pain medication (i.e., physician, friend/family, other source).
  
  
  CONCLUSIONS
  Non-medical use of prescription pain medications is associated with increased ED utilization. Further work is needed to identify the optimal role of ED settings in providing screening, education, and treatment referral for individuals using prescription pain medications non-medically.
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, United States. Electronic address: joseph.frank@ucdenver.edu.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Frank
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; Institute for Health Research, Kaiser Permanente Colorado, 10065 East Harvard Avenue, Suite 300, Denver, CO 80231, United States.
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, United States; Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, United States.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Calcaterra
authors.affiliation: Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), 1055 Clermont Street, Denver, CO 80220, United States; Departments of Psychiatry, Physical Medicine and Rehabilitation, and Neurology, University of Colorado, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045, United States.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Brenner
authors.affiliation: VA Eastern Colorado Health Care System, 1055 Clermont Street, Denver, CO 80220, United States; Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, 13199 E. Montview Blvd., Suite 400, Aurora, CO 80045, United States.
authors.forename: Cari
authors.initials: C
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: Emergency department; Health services research; Non-medical use; Opioid medications