Page 33 - Delaware Medical Journal - September/October 2018

ORIGINAL RESEARCH
INTRODUCTION
Abuse of prescription opioids in the

problem that has gained national attention over the past few years and resulted in
the development of Centers of Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain.1 In 2007, opioid analgesia overdose deaths surpassed both heroin and cocaine overdose deaths combined.2 In 2008, prescription drug overdoses in the United States caused 20,044 deaths, while opioid- containing medications were associated in 73.8% of these deaths.3
Additionally, pain-related complaints account for an estimated 42% of ED visits,4 with opioids commonly prescribed for outpatient pain control upon discharge. It has been noted that clinicians in the United States have been increasingly prescribing opioids for ED patients,
with an absolute increase of opioid prescriptions of 10.2% between 2001 and 2010. It is interesting to note that there was no change in the prescribing rate of non-opioid analgesics.5
There are differences in prescribing
and abuse patterns based on geographic location. Patients who live in rural areas
have a greater chance of receiving an opioid prescription at discharge from
the ED compared to those from urban areas.6 Overall, 17.3% of individuals who abuse opioids received prescriptions from health care providers.2 Drug- related deaths, including overdoses from both opioid and non-opioid drugs, are higher in rural areas than urban and metropolitan areas. This trend persists even when accounting for population density. Furthermore, the rate of non- medical and adolescent users of non- medical prescription opioids is higher in rural areas, with little data to ascertain the cause of this discrepancy.7
TABLE 1: Demographic comparison of patients discharged at each location
SUBURBAN ED, % (N)
P-VALUE (CHI-SQUARE)
83878
< 0.001 (62.4)
11.7 (9847)
88.3(74031)
< 0.001 (62.5)
43.5 (36488)
56.5 (47351)
0 (39)
< 0.001 (120.0)
59.3 (49727)
30.0 (25151)
10.7 (9000)
< 0.001 (7622)
31.9 (26783)
26.1 (21870)
27.4 (22999)
7.3 (6105)
7.3 (6121)
< 0.001 (360.0)
0.3 (250)
19.6 (16469)
49.3 (41328)
27.2 (22786)
3.6 (2014)
0 (31)
CHARACTERISTIC
Total Patients Discharged
Age
Age >65 Age < 65
Sex
Male
Female
Unknown
Race
White
Black
Other
Source of Payment Private insurance Medicaid
Medicare Self-pay Other Severity Index 1
2
3
4
5
Missing ESI level
URBAN ED, % (N)
45249
10.2 (4654) 89.8 (40595)
45.5 (20582) 54.5 (24665) 0 (2)
31.3 (14150) 62.2 (28157) 6.5 (2942)
13.2 (5977) 44.6 (20183) 29.0 (13111) 8.7 (3937) 4.5 (2041)
0.2 (109) 18.1 (8191) 39.1 (17700) 34.0 (15366) 8.6 (3879)
0 (4)
Del Med J | September/October 2018 | Vol. 90 | No. 7
253