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Opioid‐related Policies in New England Emergency Departments
Author(s) -
Weiner Scott G.,
Raja Ali S.,
Bittner Jane C.,
Curtis Kevin M.,
Weimersheimer Peter,
Hasegawa Kohei,
Espinola Janice A.,
Camargo Carlos A.
Publication year - 2016
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12992
Subject(s) - medicine , medical prescription , opioid , emergency department , (+) naloxone , opioid overdose , fentanyl , confidence interval , emergency medicine , metropolitan area , controlled substance , family medicine , medical emergency , psychiatry , anesthesia , nursing , receptor , pathology
Objectives The opioid abuse and overdose epidemic in the United States has led to the need for new practice policies to guide clinicians. We describe implementation of opioid‐related policies in emergency departments ( ED s) in New England to gauge progress and determine where further work is needed. Methods This study analyzed data from the 2015 National Emergency Department Inventory–New England survey. The survey queried directors of every ED ( n = 195) in the six New England states to determine the implementation of five specific policies related to opioid management. ED characteristics (e.g., annual visits, location, and admission rates) were also obtained and a multivariable analysis was conducted to identify ED characteristics independently associated with the number of opioid‐related policies implemented. Results Overall, 169 ED s (87%) responded, with a >80% response rate in each state. Implementation of opioid‐related policies varied as follows: 1) use of a screening tool for patients with suspected prescription opioid abuse potential ( n = 30, 18%), 2) access state prescription drug monitoring program ( PDMP ) before prescribing opioids ( n = 132, 78%), 3) notify the primary opioid prescriber when prescribing opioids for ED patients with chronic pain ( n = 69, 41%), 4) refer patients with opioid abuse to recovery resources ( n = 117, 70%), and 5) prescribe naloxone to patients at risk of opioid overdose after ED discharge ( n = 19, 12%). ED s located in metropolitan areas and with at least one attending physician on duty 24/7 were less likely to implement opioid policies (incident rate ratio [ IRR ] = 0.65, 95% confidence interval [ CI ] = 0.48–0.89; and IRR = 0.78, 95% CI = 0.6–1.0, respectively) while ED s with ≥15% hospitalization rate that used electronic computerized medication ordering and those in Rhode Island were more likely to implement opioid policies ( IRR = 1.23, 95% CI = 1.03–1.48; IRR = 1.95, 95% CI = 1.19–3.22; and IRR = 1.30, 95% CI = 1.08–1.56, respectively). Conclusions The implementation of opioid‐related policies varies among New England ED s. The presence of policies recommending use of screening tools and prescribing naloxone for at‐risk patients was low, whereas those regarding utilization of the PDMP and referral of patients with opioid abuse to recovery resources were more common. These data provide important benchmarks for future evaluations and recommendations.