The contribution of an emergency department to the opioid crisis.

Abstract

Misuse of prescription opioids is a significant public health issue in Australia. There has been a rapid rise in prescription opioid use over the past 20 years, with an associated increase in overdose and death.1 In the United States (USA), hospital emergency departments (ED) have been recognised as a significant source of opioid prescriptions, often provided for inappropriate indications on discharge from hospital.2 There is anecdotal concern that a similar prescribing practice may exist in Australian EDs, which could be contributing to a growing national opioid crisis. There is however limited Australian literature studying opioid prescribing in local EDs. Aim(s): Our study primarily aimed to quantify the volume of opioids prescribed on discharge from an Australian ED. As a secondary outcome, we aimed to identify any trends in prescribing behaviour. Method(s): We performed an observational, retrospective data analysis of all oral schedule 8 opioid prescriptions provided on discharge from a single-centre metropolitan ED. Data was collected for a three-year period from MerlinMapVR electronic prescribing software. Result(s): During the 2017 calendar year, 5.6% of patients presenting to the ED were discharged back into the community with a prescription for an opioid. Oxycodone immediate-release (IR) 5mg was the most frequently ordered, however there were also 303 prescriptions (8.1%) for slow-release (SR) opioids. 77.7% of opioid prescriptions allowed for a maximum quantity of tablets. The annual volume of discharge opioid prescriptions has increased over a three-year period, reaching 3, 758 prescriptions in 2017 A concerningly large number of opioids were prescribed on discharge from the ED. Oxycodone has an important role in the management of severe acute pain, however this high prevalence suggests an inappropriate overuse of this medication, especially in SR formulation. The high quantities of tablets provided per prescription may also put patients at risk of harm through the development of long-term opioid dependence. Alarmingly, the increasing trend of opioid supply into the community is suggestive of a growing problem. Hospitals should consider steps to reduce the volume of prescribed opioids into the community, such as introducing education or prescribing guidelines for junior medical staff. This may avoid contributing to a potential iatrogenic 'opioid epidemic', as experienced overseas.