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How Emergency Departments Aggravate Opioid Use

February 12, 2018 BY Alanna Moriarty

How Emergency Departments Aggravate Opioid Use

On February 7, the Senate approved funding for multiple healthcare programs after months of debate. It is estimated that more than 26 million Americans will be impacted through these community health centers over the next two years. On February 11, hot on the heels of the funding agreement, OxyContin manufacturer Purdue Pharma announced it would stop marketing the painkillers to physicians after accusations that the company contributed to the nation’s opioid epidemic. It is unclear whether other players in the pharmaceutical industry will take similar actions.

Opioid abuse has become a major population health issue throughout the U.S. in the past 30 years, and with its rise has come an increase in overdoses. Hospitalizations for opioid overdose increased 500 percent from 1993 to 2012, and prescription rates increased by around 400 percent since the mid-1980s. In 2010 alone, enough opioids were prescribed that every American could have taken a 5mg dose six times per day for a month. Experts believe that the over prescription of opioid analgesics comes, at least in part, from a lack of regulations and guidelines regarding the proper dosage and recommended length of use.

Most Prescribed Opioids by Drug Cost (Immediate Release)

Product Name

Generic Name

Days of Supply

Drug Cost (M)

OXYCONTIN

Oxycodone Hcl

41,572,125

$824

OXYCODONE HCL

Oxycodone Hcl

150,002,040

$252

OPANA ER

Oxymorphone Hcl

6,130,085

$123

TRAMADOL HCL

Tramadol Hcl

322,019,090

$101

OXYMORPHONE HCL ER

Oxymorphone Hcl

3,352,660

$39

ACETAMINOPHEN-CODEINE

Acetaminophen With Codeine

44,998,714

$35

NUCYNTA ER

Tapentadol Hcl

1,461,105

$24

HYDROMORPHONE HCL

Hydromorphone Hcl

19,562,683

$22

Fig 1 Data on opioid prescription patterns from Definitive Healthcare based on Days of Supply

The popularity of opioid drugs lies in its adaptability: as codeine in cold and flu medications, as naloxone to reverse the effects of overdose, and as morphine and other pain relief medications. Because of its reputation as a powerful pain reliever, opioids are commonly prescribed in hospital emergency departments (EDs) during recovery from traumatic injuries and surgeries. However, rates of opioid prescription vary widely, even in the same ED. Patients treated by an ED physician with a high opioid prescribing rate were more likely to struggle with long-term opioid use than patients treated by a physician with a low opioid prescribing rate. Studies also show that ED opioid prescriptions do not prevent or reduce likelihood of future ED admissions. It is estimated that 1 in 48 ED patients prescribed an opioid for the first time will become a long-term user.

Older Americans are particularly vulnerable to complications associated with opioid use. The elderly population is more susceptible to the sedative effects of many opioid medications, leading to increased rates of falls, bone fractures, and even death. If serious injury does occur, elderly patients may continue to receive prescription opioids—further exacerbating the problem.

Most Prescribed Opioids by Drug Cost (Extended Release)

Product Name

Generic Name

Days of Supply

Drug Cost (M)

OXYCONTIN

Oxycodone Hcl

41,572,125

$824

FENTANYL

Fentanyl

76,515,590

$295

MORPHINE SULFATE ER

Morphine Sulfate

89,280,311

$287

OXYCODONE HCL

Oxycodone Hcl

150,002,040

$252

SUBSYS

Fentanyl

344,307

$136

OPANA ER

Oxymorphone Hcl

6,130,085

$123

TRAMADOL HCL

Tramadol Hcl

322,019,090

$101

OXYMORPHONE HCL ER

Oxymorphone Hcl

3,352,660

$39

Fig 2 Data on opioid prescription patterns from Definitive Healthcare based on Days of Supply

Pharmacists may hold the key to reducing the rate of opioid prescription. A study from the Journal of the American Board of Family Medicine found that providing physicians with pharmacist recommendations for opioid dosage and use before patient visits correlated with lower rates of opioid use and did not lead to an increase of patient pain scores. Though ED physicians are major suppliers, primary care physicians (PCPs) are responsible for more than 50 percent of all prescription opioids. Providing PCPs with more information on proper usage of opioid medications could decrease the number of prescriptions given to patients, reducing the rate of long-term use and abuse over time.

The Centers for Disease Control and Prevention (CDC) released guidelines for providers regarding prescription opioids. Some of these recommendations include:

  • A patient’s first opioid prescription should be immediate-release
  • Opioid medication supply for acute pain should not exceed 3 days
  • Clinicians should prescribe the lowest effective dosage—less than 50 MME (morphine milligram equivalents) per day—and avoid exceeding 90 MME per day

Between 2009 and 2013, 97 percent of all opioid prescriptions abided by these guidelines. However, more than 25 percent of initial prescriptions exceeded the recommended dosage. In addition, nearly 60 percent of opioid prescriptions for acute pain were supplied for 4 or more days. These factors could lead to an increased risk for long-term opioid use and dependence.

Opioid Use Statistics

Fig 3 Data from Definitive Healthcare

The two-year funding of community health centers is one step toward reducing opioid use and abuse in the United States. Federal funding coupled with CDC guidelines and other educational resources for providers, it is entirely possible to reduce the number of opioid prescriptions given to patients by PCPs and ED physicians—and, therefore, opioid abuse.

If you’d like to learn more about the role pf physicians and care providers in addressing the opioid crisis, register for the HLTH Conference, May 6-9 in Las Vegas. Use the code "definitive_150" for $150 off your registration, and be sure to visit us at booth #12042. Other topics of discussion include: how to transform health data into meaningful solutions, the shifting roles of healthcare leaders, strategies to improve ROI, and much more.

Visit the Definitive Blog to read more about the Costs of Specialty Pharmaceuticals.

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