title: Trends in Opioid Analgesic Use in Encounters Involving Physician Trainees in U.S. Emergency Departments.
abstract: Opioid analgesic use has increased dramatically in emergency departments (EDs), but the relative contribution of physician trainees has not been explored. We assessed trends in opioid utilization focusing on ED encounters where a physician trainee was involved.
  
  
  
  We studied ED visits from the National Hospital Ambulatory Medical Care Survey, 2001-2011. Adult ED visits in which an opioid was administered in the ED or prescribed at discharge were stratified by whether or not there was trainee involvement. Trends in use over time for five common opioids (codeine, hydrocodone, hydromorphone, morphine, oxycodone) were tested using survey-weighted logistic regression.
  
  
  
  From 2001-02 to 2009-11, the proportion of ED visits where an opioid analgesic was used increased 31.5% from 21.9% (95% CI: 20.3-23.6) of visits to 28.8% (95% CI: 27.5-30.1). Trainee involvement in ED visits was stable, with 9.3% (95% CI: 7.7-11.3) seen by a trainee in 2001-02 vs. 10.2% (95% CI: 8.1-12.7) in 2010-11. Opioid use in visits with trainee involvement did not change significantly over time relative to visits without a trainee (increase of 36.8% compared to 31.2% without trainees, P = 0.652). Trends in opioid utilization for trainee visits paralleled non-trainee visits. Hydromorphone had the greatest relative increase in use for all providers. Adjusted for patient- and hospital-level factors, the probability of receiving opioids when a trainee was involved increased to a greater extent than among non-trainee visits (30.9% vs. 24.0%).
  
  
  
  Opioid utilization patterns for visits involving trainees reflect similar trends in attending practice, and highlights the more liberal opioid prescribing climate over time.
authors.affiliation: *Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.|Georgetown University School of Medicine, Washington, DC.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.affiliation: Center for Clinical Practice Innovation, The George Washington University, Washington, DC.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Mullins
authors.affiliation: *Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.|Georgetown University School of Medicine, Washington, DC.
authors.forename: Christie
authors.initials: C
authors.lastname: Sun
authors.affiliation: Center for Clinical Practice Innovation, The George Washington University, Washington, DC.|Department of Emergency Medicine, The George Washington University, Washington, DC.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.affiliation: Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York.|*Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jeanmarie
authors.initials: J
authors.lastname: Perrone
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000701:Analgesics, Opioid
keywords: Emergency Department; Opioids; Trainee