Opioid Prescriptions From ED Less Likely To Result In Fatalities

Despite the daily problems of drug-seekers and limited knowledge about patients’ medical history, emergency physicians are far from major offenders when it comes to opioid prescriptions that lead to fatalities, according to a new study presented at the recent meeting of the American Academy of Pain Medicine. You might be surprised to find out which specialty’s prescribing practices result in the most deaths, three times higher than expected.

Emergency physicians know to watch for patients addicted to pain killers and trying to score a prescription in a busy ED with phantom symptoms. You also see the fatal results of opioid abuse with sobering frequency. Perhaps that’s why you and your emergency physician colleagues have the lowest overall ratio of deaths to opioid prescriptions written of all specialties—just one-quarter of the rate that would be expected based on the number of prescriptions written.

Researchers at the University of Utah presented preliminary results of a study of physician specialty and prescription opioid fatalities at the recent American Academy of Pain Medicine meeting that found that family medicine physicians write 27.5% of opioid prescriptions and are associated with the largest percentage of opioid deaths (35%).

Other specialties, however, have a much higher ratio of deaths to prescriptions. Pain medicine physicians had the highest rate, with 3 times as many deaths as expected based on the number of prescriptions written. Anesthesiologists and rehabilitation specialists both had more than twice as many deaths as would be expected. Internists, orthopedic surgeons, and dentists accounted for a lower proportion of fatalities, as did physician assistants.

Researchers analyzed data from more than 30 million records in the Utah Controlled Substance Database from 2005 to 2009 and linked DEA numbers with National Provider Identities to determine specialty. Fatality data was provided by the Utah medical examiner’s office.

Overall, just 0.475% of opioid prescriptions were associated with fatalities, but those accounted for 67% of all drug overdose deaths in Utah, according to related research by the same team. Of those who died, 53% had received treatment for substance abuse and 25% were reported to have abused pain medication in the previous year. More than 54% had been diagnosed with a mental illness. Screening for mental health status may help emergency physicians push down their fatality rates associated with opioid prescriptions even further, the study noted.

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