July 24, 2018
The likelihood that a medical professional will prescribe an opioid for a minor injury varies dramatically across the United States, according to new research out of the University of Pennsylvania.
Researchers examined private insurance claims for nearly 31,000 patients who visited emergency departments for an ankle sprain between 2011 and 2015. Nationwide, 25 percent of them were prescribed an opioid painkiller, such as hydrocodone or oxycodone.
But the likelihood of receiving such a prescription varied considerably by state.
Patients who were treated in states considered "high prescribers" were about three times as likely to receive an opioid prescription than those seeking treatment in states considered "low prescribers."
That disparity was particularly glaring at the extremes. Patients in Arkansas, the highest-prescribing state, were more than 10 times more likely to receive an opioid prescription than patients in North Dakota, the lowest prescribing state.
The highest-prescribing states mostly were located in the south. The stingiest states, including Pennsylvania and New Jersey, were mostly located in the north.
Patients in Pennsylvania received an opioid prescription 13.2 percent of the time. In New Jersey, they received an opioid prescription 10.9 percent of the time.
Opioids are not the first treatment for an ankle sprain – nor should they be, said Dr. M. Kit Delgado, the study's lead researcher and a Penn professor of emergency medicine and epidemiology. But he stressed opioid prescriptions are too common and too variable for such minor injuries.
“Given that we cannot explain this variation after adjusting for differences in patient characteristics, this study highlights opportunities to reduce the number of people exposed to prescription opioids for the first time and also to reduce the exposure to riskier high-intensity prescriptions," Delgado said.
Additionally, the study found that patients who received long-course prescriptions were five times more likely to fill additional opioid prescriptions during the next six months than patients who only received a small supply. The study found that long-course prescriptions were associated with prolonged use unrelated to the original injury.
Medical professionals must maximize non-opioid alternatives when treating minor injuries, the researchers suggested. When an opioid is necessary, they recommended that the lowest initial dose be prescribed – no more than 10-12 tablets of short-acting drugs.
“Although prescribing is decreasing overall, in 2015 nearly 20 percent of patients who presented with an ankle sprain were still given an opioid, a modest decrease from 28 percent in 2011,” Delgado said. “By drilling down on specific common indications as we did with ankle sprains, we can better develop indicators to monitor efforts to reduce excessive prescribing for acute pain.”
The study was funded by the National Institute on Drug Abuse and the Leonard Davis Institute Small Grants program. Its findings were published Tuesday in the Annals of Emergency Medicine.