Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis - Woitok, B. K.; Buttiker, P.; Ravioli, S.; Funk, G. C.; Exadaktylos, A. K.; Lindner, G. (BMJ Open, 2020)
OBJECTIVES: We aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED). DESIGN: Retrospective chart review. SETTING: Large, interdisciplinary ED of a public hospital. PARTICIPANTS: All patients aged >/=18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence rates for prescription opioid use and its indication. Prevalence of analgesic comedications in prescription opioid users. Hospitalisation rate, 72 hours ED reconsultation rate, 30-day rehospitalisation rate, in-hospital mortality. RESULTS: A total of 26 224 consultations were included in the analysis; 1906 (7.3%) patients had prescriptions for opioids on admission to the ED. The main indications for opioid prescriptions were musculoskeletal disease in 1145 (60.1%) patients, followed by neoplastic disease in 374 (19.6%) patients. One hundred fifty-four (8.2%) consultations were directly related to opioid intake, and 50.1% of patients on opioids also used other classes of analgesics. Patients on prescription opioids were older (76 vs 62 years, p<0.0001) and female individuals were over-represented (58 vs 48.9%, p<0.0001). Hospitalisation rate (78.3 vs 49%, p<0.0001), 72 hours ED reconsultation rate (0.8 vs 0.3%, p=0.004), 30-day rehospitalisation rate (6.2 vs 1.5%, p<0.0001) and in-hospital mortality (6.3 vs 1.6%, p<0.0001) were significantly higher in patients with opioid therapy than other patients. In 25 cases (1.3%), admission to the ED was due to opioid intoxication. CONCLUSIONS: Daily prescription opioid use is common in patients presenting to the ED. The use of prescription opioids is associated with adverse outcomes, whereas intoxication is a minor issue in the studied population.
Keywords: journalArticle; *Analgesics, Opioid/therapeutic use; *Emergency Service, Hospital; Adolescent; Adult; Female; Humans; Practice Patterns, Physicians'; Prescriptions; Retrospective Studies; Switzerland/epidemiology; accident & emergency medicine; internal medicine; pain management