In This Edition
Literature at a Glance
A guide to this month’s studies
Explore this issue:March 2011
- Risk of adverse events with opioid use
- Drug of choice for outpatient treatment of cellulitis
- Preventing hospital falls
- Post-hospital outcomes based on status of PCP follow-up
- LOS, mortality, and readmission based on insurance
- Antiplatelets added to warfarin for atrial fibrillation.
- Cognitive effects of severe sepsis
- Effect of preoperative furosemide use
ED Visits Are Higher among Recipients of Chronic Opioid Therapy
Clinical question: Is there an association between the use of prescription opioids and adverse outcomes?
Background: Chronic opioid therapy is a common strategy for managing chronic, noncancer pain. There has been an increase in overdose deaths and ED visits (EDV) involving the use of prescription opioids.
Study design: Retrospective study from claims records.
Setting: Population in the Health Core Integrated Research Database, containing large, commercial insurance plans in 14 states, and Arkansas Medicaid.
Synopsis: Patients 18 and older without cancer diagnoses who used prescription opioids for at least 90 continuous days within a six-month period from 2000 to 2005 were examined for risk factors for EDVs and alcohol- or drug-related encounters (ADEs) in the 12 months following 90 days or more of prescribed opioids.
Patients with diagnoses of headache, back pain, and pre-existing substance-use disorders had significantly higher EDVs and ADEs. Opioid dose at morphine-equivalent doses over 120 mg per day doubled the risk of ADEs. The use of short-acting Schedule II opioids was associated with EDVs (relative risk, 1.09-1.74). The use of long-acting Schedule II opioids was strongly associated with ADEs (relative risk, 1.64-4.00).
Bottom line: In adults with noncancer pain prescribed opioids for 90 days or more, short-acting Schedule II opioid use was associated with an increased number of EDVs, and long-acting opioid use was associated with an increased number of ADEs. Minimizing Schedule II opioid prescription in these higher-risk patients might be prudent to increase patient safety.
Citation: Braden JB, Russo J, Fan MI, et al. Emergency department visits among recipients of chronic opioid therapy. Arch Intern Med. 2010; 170(16):1425-1432.