Dramatic Increase in Emergency Department Visits Resulting From Prescription Opioid Use

Deborah Brauser

June 29, 2010

June 29, 2010 — The estimated number of emergency department (ED) visits involving nonmedical use of prescription opioids increased by 111% during a 5-year period, according to a new study by researchers from the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Oxycodone, hydrocodone, and methadone products were the opioid pain relievers most frequently involved in these visits, with increases of 152%, 123%, and 73%, respectively.

"These alarming findings provide 1 more example of how the misuse of prescription pain relievers is impacting lives and our health care system," said Pamela S. Hyde, JD, administrator of SAMSHA, Rockville, Maryland, in a statement. "This public health threat requires an all-out effort to raise awareness of the public about proper use, storage, and disposal of these powerful drugs."

"We urgently need to take action," echoed Thomas R. Frieden, MD, MPH, director of the CDC in Atlanta, Georgia, in the same statement. "[ED] visits involving non-medical use of these prescription drugs are now as common as [ED] visits for use of illicit drugs. These prescription medicines help many people, but we need to be sure they are used properly and safely."

The findings were reported jointly in a SAMHSA survey report and in the CDC's Morbidity and Mortality Weekly Report, published online June 17.

Important Public Health Issue

"This is something we've been tracking for a number of years, and it's been pretty clear that prescription drug use has been growing over time," Peter Delany, PhD, director of the Office of Applied Studies at SAMSHA, told Medscape Psychiatry. "This [study] was an opportunity for us to work with our partners at CDC to look at 5 years worth of data and to track trends.

"It was a real collaboration with our colleagues at CDC and we were very happy to do it as a joint project, especially because this is a critically important public health issue," added Dr. Delany.

The investigative team evaluated a "stratified, simple random sample" from 220 hospitals with 24-hour EDs between the years 2004 and 2008 from SAMHSA's Drug Abuse Warning Network ED system.

Nonmedical use of a prescription drug was defined as "taking a higher-than-recommended dose, taking a drug prescribed for another person, drug-facilitated assault, or documented misuse or abuse," according to the study authors.

Dramatic Increases

Results showed that the nonmedical use of prescription opioids rose significantly from 144,600 ED visits in 2004 to 305,900 visits in 2008 (P < .001). It also increased by 29% just between the years 2007 and 2008.

In addition, ED visits during the 5-year period involving nonmedical oxycodone use rose significantly from 41,700 to 105,214 visits a year (P < .001). Hydrocodone involvement rose from 39,844 to 89,051 visits, and methadone product involvement rose from 36,806 to 63,629 visits.

These increases "reflect, in part, substantial increases in the prescribing of these classes of drugs," the investigators write.

When researchers also looked at the estimated number of nonmedical benzodiazepine-related ED visits, they found an overall increase by 89% between 2004 and 2008 (from 143,500 to 271,700 visits; P = .01).

Individual benzodiazepines also showed significant rises in ED visits during the study period, including a 125% increase for alprazolam (P = .01), 107% increase for lorazepam (P = .006), 72% increase for clonazepam (P < .001), and 70% increase for diazepam (P = .02). Benzodiazepines were involved in 26% of all opioid-related visits.

Age-specific rates of ED visits in 2008 showed a sharp increase for both opioids and benzodiazepines "after age 17 years, [peaking] in the 21 to 24 years age group, and [declining] after age 54 years," report the study authors. "The largest increases during 2004 to 2008 occurred among persons aged 21 to 29."

Although women had more benzodiazepine-related ED visits than men in 2008 (152,100 vs 119,600, respectively), the difference was not statistically significant.

"These findings indicate substantial, increasing morbidity associated with the nonmedical use of prescription drugs...despite recent efforts to control the problem," write the study authors. "Stronger measures to reduce the diversion of prescription drugs to nonmedical purposes are warranted."

Opportunity for Prevention and Education

"I think the number 1 takeaway is that this is an opportunity for [clinicians] to really think about these findings and then talk about them with their patients," said Dr. Delany. "It's also an opportunity for prevention and education. How do you store and dispose of medications when you don't need them anymore? These answers need to be given not just by the clinician who is prescribing medications but also by pharmacists and other health providers. Also, adults need to be aware of what's going on in their medicine cabinets, especially if there are [young people] in the household."

"The abuse of prescription drugs is our nation's fastest-growing drug problem. And this new study shows it is a problem that affects men and women, people under 21, and those over 21," said R. Gil Kerlikowske, director of the Office of National Drug Control Policy in Rockville, Maryland, in a statement.

"The newly released National Drug Control Strategy contains specific steps that all of us can take to address this issue," added Director Kerlikowske.

Dr. Delany noted that SAMHSA and the CDC plan on participating in more joint research partnerships. "There's a real commitment between my administrator and Dr. Frieden at CDC to keep building on the collaborations that we have done over the years.

"We're a behavioral health statistical unit while their researchers really look at health areas. So the ability to bring behavioral health and health together for these types of mainstream health issues is important, especially because they're both so intertwined," said Dr. Delany.

The study authors and commentators have disclosed no relevant financial relationships.

SAMHSA. "The DAWN Report — Trends in Emergency Department Visits Involving Nonmedical Use of Narcotic Pain Relievers." Released June 18, 2010.

Morb Mortal Wkly Rep. "[ED] Visits Involving Nonmedical Use of Selected Prescription Drugs." Published online June 17, 2010.

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