OBJECTIVES: Emergency Departments (ED) are at the forefront of the opioid epidemic, and ED providers are striving to develop safer clinical practice strategies to address this epidemic. The CDC recommends employing multimodal analgesics for acute pain, and warns against co-prescribing of opioids and benzodiazepines. This analysis describes the change in annual opioid prescribing rates, types of opioids prescribed, and concomitant medications for patients discharged from one urban ED.

METHODS: This retrospective study utilized the electronic medical records for all patient encounters discharged with and without a controlled substance opioid prescription from one urban academic ED from 2011–2016. Opioids that were Schedule II-IV Controlled Substances per the US Drug Enforcement Agency were included. Non-opioid analgesics include acetaminophen, aspirin, NSAIDs, muscle relaxants, local anesthetics, and topical analgesics. Descriptive statistics including Chi-square were used to analyze the change in proportion of patients discharged with an opioid prescription and differences in types of opioids prescribed.

RESULTS: From 2011-2016, 31,286 of 246,421 (12.7%) patients discharged from the ED received an opioid prescription; 54.3% were female and mean (SD) age was 44. (15.7) years. Each year the proportion of patients receiving an opioid decreased, with the highest rate (17.9%) in 2011 and the lowest rate (6.1%) in 2016 (p<0.001). In 2011, the most widely prescribed opioids were oxycodone (68.6%), codeine (14.3%), and hydrocodone (13.3%). In 2016, oxycodone was still the most widely prescribed (58.0%), followed by tramadol (29.7%), codeine (7.7%), and hydrocodone (4.6%). Commonly co-prescribed medications were non-opioid analgesics (85.6%), antibiotics (24.2%), and benzodiazepines (3.4%).

CONCLUSIONS: The proportion of patients discharge with an opioid prescription from a single ED decreased by 66% from 2011-2016. The reduction may be due to focused education and increased awareness within the EDs, but further research is warranted to elucidate this trend and determine factors associated with decreased opioid prescribing.