title: The Contribution of the Emergency Department To Opioid Pain Reliever Misuse And Diversion: A Critical Review.
abstract: Prescription opioid pain reliever (OPR) misuse and diversion is an important and growing public health problem in the United States that is responsible for significant morbidity and mortality. Emergency physicians are among the top prescribers of OPRs, yet the relative contribution of emergency department (ED) OPR prescriptions to the overall opioid abuse epidemic remains unclear. This study critically reviews seven peer-reviewed studies that specifically identified the ED as a source of OPRs. Of the OPRs prescribed in the ED, approximately 10% are associated with indicators of inappropriate prescribing, and approximately 42% may ultimately be misused; of the OPRs that are diverted, approximately 10% originate from an ED prescription. Among patients who suffer an OPR-related death, approximately 1.8% of the OPR pills given to the decedents will have come from the ED. In addition to the need for more research, the existing literature suggests an urgent need for interventions in the ED to reduce OPR misuse and diversion.
authors.affiliation: University of Connecticut Health Center, Farmington, Connecticut, U.S.A.|Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Lyapustina
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
authors.forename: Renan
authors.initials: R
authors.lastname: Castillo
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
authors.forename: Elise
authors.initials: E
authors.lastname: Omaki
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
authors.forename: Wendy
authors.initials: W
authors.lastname: Shields
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
authors.forename: Eileen
authors.initials: E
authors.lastname: McDonald
authors.affiliation: Division of Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, U.S.A.
authors.forename: Richard
authors.initials: R
authors.lastname: Rothman
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, U.S.A.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gielen
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D006801:Humans; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000701:Analgesics, Opioid
keywords: opioid analgesics; opioid-related disorders; self medication