ED opioid prescriptions for ankle sprain linked to long-term use among opioid-naive

  • Delgado MK & al.
  • Ann Emerg Med
  • 24 Jul 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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).

Study design

  • 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.

Limitations

  • Rising heroin availability could depress prolonged opioid use measure.

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