Opioid prescribing in emergency departments: the prevalence of potentially inappropriate prescribing and misuse

Med Care. 2013 Aug;51(8):646-53. doi: 10.1097/MLR.0b013e318293c2c0.


Objective: Emergency departments (EDs) routinely provide care for patients seeking treatment for painful conditions; however, they are also targeted by people seeking opioid analgesics for nonmedical use. This study determined the prevalence of indicators of potential ED opioid misuse and inappropriate prescription practices by ED providers in a large, commercially insured, adult population.

Research design and indicators: We analyzed the 2009 Truven Health MarketScan Research Databases to examine the ED visits of enrollees aged 18-64 years. Indicators used to mark potential inappropriate use included opioid prescriptions overlapping by one week or more; overlapping opioid and benzodiazepine prescriptions; high daily doses (≥100 morphine milligram equivalents); long-acting/extended-release (LA/ER) opioids for acute pain, and overlapping LA/ER opioids. Analyses were stratified by sex.

Results: We identified 400,288 enrollees who received at least one ED opioid prescription. At least one indicator applied to 10.3% of enrollees: 7.7% had high daily doses; 2.0% had opioid overlap; 1.0% had opioid-benzodiazepine overlap. Among LA/ER opioid prescriptions, 21.7% were for acute pain, and 14.6% were overlapping. Females were more likely to have at least one indicator.

Conclusions: In some instances, the prescribing of opioid analgesics in EDs might not be optimal in terms of minimizing the risk of their misuse. Guidelines for the cautious use of opioid analgesics in EDs and timely data from prescription drug monitoring programs could help EDs treat patients with pain while reducing the risk of nonmedical use.

MeSH terms

  • Adolescent
  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Benzodiazepines / administration & dosage
  • Delayed-Action Preparations
  • Drug Combinations
  • Drug Utilization / statistics & numerical data*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Inappropriate Prescribing / statistics & numerical data*
  • Insurance Claim Review / statistics & numerical data
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / statistics & numerical data*
  • United States
  • Young Adult


  • Analgesics, Opioid
  • Delayed-Action Preparations
  • Drug Combinations
  • Benzodiazepines