Prescription Opioids Involved in Most Overdoses in the ED

Megan Brooks

October 29, 2014

Prescription opioids, including methadone, are involved in more than two thirds of opioid overdose cases seen in US emergency departments (EDs), a new study shows.

The findings suggest that further efforts to combat the problem are "urgently needed," Michael A. Yokell, ScB, from Stanford University School of Medicine in California, and colleagues conclude in a research letter published online October 27 in JAMA Internal Medicine.

Using the Nationwide Emergency Department Sample, they identified 135,971 ED visits for opioid overdose in 2010. They report that 67.8% of overdoses involved prescription opioids, while heroin accounted for 16.1% of overdoses, unspecified opioids for 13.4%, and multiple opioid types for 2.7%.

The greatest proportion of prescription opioid overdoses happened in urban areas (84.1%), in the South (40.2%), and among women (53%). Most overdose patients had health insurance.

Michael A. Yokell

The researchers say several comorbidities were common among these opioid overdose cases, including chronic mental (33.9%), circulatory (29.1%), and respiratory (25.6%) diseases, "suggesting a need for clinicians to exercise care when prescribing opioids to patients with these conditions," Yokell told Medscape Medical News.

"Co-intoxication with benzodiazepines was seen in 22% of patients, indicating a need for very cautious prescribing of opioids in conjunction with other sedating medications," he said.

Once patients arrived in the ED, the overall death rate was low (1.4%), which "supports efforts to expand access to and utilization of emergency medical services," Yokell said.

Roughly half of all overdose patients seen in the ED were admitted to the hospital (50.6%), and costs for both inpatient and ED charges approached $2.3 billion.

"Pressing" Public Health Issue

Yokell noted that "much of the current understanding of the opioid overdose epidemic is based on mortality data gathered from medical examiners and death certificates. Little is known, however, about the many more people who experience an opioid overdose and survive."

Their study used a national emergency department dataset to examine the basic clinical and demographic characteristics of patients presenting to US emergency departments with opioid overdose, he said. "We found critical geographic and clinical differences among overdose victims, which have important implications for overdose prevention and response interventions."

"Although our study did not investigate interventions for this pressing public health issue, we know from existing data that we can do more on the local, state, and national levels to address the opioid overdose epidemic," Yokell added.

"More resources should be directed to enhance access to naloxone (the antidote for opioid overdose), increase safe prescribing practices among clinicians, raise awareness about the risks of overdose among people who use prescription and non-prescription opioids, and ensure that overdose victims have access to life-saving emergency medical services," he said.

The study was supported by Stanford University School of Medicine and by grants from the Centers for Disease Control and Prevention, the National Institutes of Health, National Center for Research Resources, and National Center for Advancing Translational Sciences, and the National Heart, Lung, and Blood Institute. The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online October 27, 2014. Abstract

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