• Molly Moore Jeffery, W Michael Hooten, Erik P Hess, Ellen R Meara, Joseph S Ross, Henry J Henk, Bjug Borgundvaag, Nilay D Shah, and BellolioM FernandaMFDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN..
• Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN. Electronic address: jeffery.molly@mayo.edu.
• Ann Emerg Med. 2018 Mar 1; 71 (3): 326-336.e19.

Study ObjectiveWe explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients' continuing long-term opioid use.MethodsWe used analysis of administrative claims data (OptumLabs Data Warehouse 2009 to 2015) of opioid-naive privately insured and Medicare Advantage (aged and disabled) beneficiaries to compare characteristics of opioid prescriptions attributed to the ED with those attributed to other settings. Concordance with Centers for Disease Control and Prevention (CDC) guidelines and rate of progression to long-term opioid use are reported.ResultsWe identified 5.2 million opioid prescription fills that met inclusion criteria. Opioid prescriptions from the ED were more likely to adhere to CDC guidelines for dose, days' supply, and formulation than those attributed to non-ED settings. Disabled Medicare beneficiaries were the most likely to progress to long-term use, with 13.4% of their fills resulting in long-term use compared with 6.2% of aged Medicare and 1.8% of commercial beneficiaries' fills. Compared with patients in non-ED settings, commercial beneficiaries receiving opioid prescriptions in the ED were 46% less likely, aged Medicare patients 56% less likely, and disabled Medicare patients 58% less likely to progress to long-term opioid use.ConclusionCompared with non-ED settings, opioid prescriptions provided to opioid-naive patients in the ED were more likely to align with CDC recommendations. They were shorter, written for lower daily doses, and less likely to be for long-acting formulations. Prescriptions from the ED are associated with a lower risk of progression to long-term use.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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