Patients prescribed opioids for minor injuries at high risk of long-term use

Hospital emergency department

Exercising caution when prescribing opioids for patients with minor injuries in A&E departments is critical for the prevention of prolonged opioid use, according to researchers from the University of Pennsylvania.

The study results show that patients who received 30 or more opioid pills for the treatment of a minor injury, such as a sprained ankle, were twice as likely to fill an additional opioid prescription within three to six months, compared with those who received fewer than 15 pills (adjusted odds ratio 1.97, 95% confidence interval [CI] 1.48–2.62).

The researchers, who presented their findings at the Society for Academic Emergency Medicine annual meeting on 17 May 2017[1]
, looked at private insurance claims data from 53,222 patients visiting emergency departments in the United States for an isolated ankle sprain in 2011–2012.

Of these, 7.1% received a prescription for an opioid. The average quantity of hydrocodone or oxycodone received was 20 pills and 5% received 60 pills or more.

The researchers then examined the association between the quantity of opioids supplied to patients in the first instance and whether or not another prescription was requested in the following 90–180 days.

The researchers calculated that if all opioid prescriptions were written for 20 pills, there would have been 37,721 fewer opioid pills entering the community during this time period.

“If extrapolated more broadly to the treatment of other minor injuries, this likely translates to millions of highly addictive and unnecessary prescribed pain medications filtering into the community,” says M. Kit Delgado, assistant professor of emergency medicine and epidemiology and lead author on the study.

“The study illustrates the potential benefit of laws to limit new opioid prescriptions for acute pain to no more than a five-day supply, as was recently passed in New Jersey.”

References

[1] Delgado MK, Huang Y, Meisel Z et al. National variation in opioid prescribing and risk of prolonged opioid use for opioid-naïve patients treated in the emergency department for ankle sprains. Abstract presented at the Society for Academic Emergency Medicine annual meeting in Orlando, Florida, 17 May 2017.

Last updated
Citation
The Pharmaceutical Journal, May 2017;Online:DOI:10.1211/PJ.2017.20202804