- Opioid prescriptions for ankle sprain in the emergency department (ED) are associated with higher risk for prolonged use.
- Authors: findings “support the importance of keeping opioid-naive patients opioid-naive” and suggest “ample opportunity to reduce excessive prescribing.”
Why this matters
- Studies linking opioid prescriptions to prolonged use have failed to adjust for confounding by indication.
- Ankle sprain can be effectively treated without opioids.
- Opioid prescription rate: 25.1% (n=7739).
- Prescription rates: from 40.0% (Arkansas) to 2.8% (North Dakota).
- Prolonged opioid use, with vs without initial opioid prescription: 0.73% (95% CI, 0.63%-0.84%) vs 0.50% (95% CI, 0.40%-0.59%).
- Prolonged opioid use risk (adjusted, based on morphine milligram equivalents [MMEs]):
- At ≤75 MMEs: 1.10% (95% CI, 0.72%-1.53%);
- >225 MMEs: 4.9% (95% CI, 1.8%-8.1%);
- Above risks rose with higher-potency initial opioids (hydrocodone or oxycodone).
- Retrospective cohort analysis, insurance claims for opioid-naive US adults treated in EDs for ankle sprain, 2011-2015 (n=30,832).
- Outcomes included:
- Opioid prescription rate (prescription filling within 3 days of ED encounter);
- Rate of transition to prolonged opioid use (≥4 prescriptions filled within 30-180 days of encounter).
- Funding: NIH; University of Pennsylvania.
- Rising heroin availability could depress prolonged opioid use measure.