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OPIOID PRESCRIBING

Molly Short RN
NSG 471

Opioid Prescribing

Barnett M.D., M., Olenski B.S., A., & Jena M.D., Ph.D., A. (2017, February 16). Opioid-
Prescribing Patterns of Emergency Physicians and ... The New England Journal of
Medicine. https://www.nejm.org/doi/pdf/10.1056/NEJMsa1610524.

In this retrospective analysis, the researchers hypothesized a link between the opioid-

prescribing habits of physicians and potential for long-term use by the patients. Their sample

population were Medicare beneficiaries with an emergency room visit over a 4-year period

(2008-2011). They standardized “prescribing patterns” of the physicians based on prescribing

rates in same hospital. The pattern was identified as “high-intensity “or “low-intensity”

prescriber. Their working definition of “long-term opioid use” was 6 months of days supplied,

in the 12 months after visit to emergency department. Identified for each patient was whether

their treating emergency physician was a “high-intensity” or “low-intensity” prescriber.

Adjustments were made for patient characteristics.

A sample of 377,629 patients was examined; 215,678 of the sample received treatment from low

intensity prescriber and 161,951 patients received treatment from high intensity prescriber. The

patient population had similar characteristics including diagnoses for each group. The patients

used in the study had not had an opioid prescription filled within 6 months of emergency

department visit, excluded visits that ended up with hospitalizations, and hospice patients. The

researchers obtained their data by reviewing Medicare claim records. The researchers chose 6

months for the working definition of long-term opioid use because the would capture the renewal

of prescriptions by other providers after initial emergency department visit.

Emergency department physicians were used for the study since a choice of physicians is random

assignment when going to an emergency department. The researchers felt that this would better
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OPIOID PRESCRIBING

reflect physician decisions about prescribing opioids based on the presenting characteristics of

the patient. Additionally, the researchers looked at whether the low intensity prescribing

physicians under-treated the pain in their patients by looking at repeat visits within 30 days for

the same diagnoses.

The conclusions of the study indicated that the high intensity prescribers’ patients did have a

higher incidence of long-term opioid use versus the low-intensity prescribers. It was identified

in the results that rates of opioid-related hospital encounters for falls and/or fractures were higher

in the 12 months after the initial emergency department visit with treatment by the high intensity

prescriber. No significant re-visits were identified for low intensity prescribers.

This research provided a wealth of information that could provide a basis for future studies. No

specific causal relationships between high and low intensity prescribers and long-term use could

be identified but the indication is in the data that high intensity prescribers’ patients tend to

develop long-term use of opioids. Further study would need to be done with a broader

population since the Medicare patients in the study population are not indicative of the whole

population. The increased incidence of opioid related accidents was interesting and could lead to

further research on opioid use with the elderly. The results of the study indicate that opioid

prescribing levels need to be further reviewed, studied, and perhaps standardized at different

levels than currently in use. This is a timely topic due to the enormous impact the opioid crisis

has had on our country’s economi. Overall, it was a good study that provides a basis for several

key avenues of further research to reduce the long-term use/abuse of opioids and the adjust levels

of the drug prescribed to different populations based on side effects.