In a recent study, researchers at Penn Medicine found that where people live in the U.S. could determine how many opioids they can get.
Patients who sought care for a sprained ankle in states that were found to be “high prescribers” of opioids were about three times more likely to receive a prescription for the drugs than those treated in “low-prescribing” states,
In addition, the study showed that patients who received prescriptions for long courses of the drugs (e.g. more than 30 tablets of oxycodone 5 mg) were five times more likely to fill additional opioid prescriptions over the next 6 months than those who received just a few days’ supply (e.g. 10 tablets of less).
The findings show wide geographic variability in prescribing patterns for minor injuries.
Although opioids are not – and should not – be the first-line treatment for an ankle sprain, opioid prescribing for these minor injuries is still common and far too variable.
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.
In the study, the researchers examined private insurance claims data from more than 30,800 patients visiting U.S. emergency departments for an ankle sprain from 2011-2015.
All patients included in the study had not filled an opioid prescription within the past six months.
Overall, 25% of patients received a prescription for an opioid pain medication (such as hydrocodone or oxycodone).
In total, more than 143,000 opioid tablets were prescribed for patients in the study sample who filled prescriptions.
However, there was wide variation between the low vs. high prescribing states.
And at the extremes, it was over tenfold, with only three percent of patients received an opioid prescription in North Dakota, compared to 40% in Arkansas.
The overall pattern of variation across states suggests that there is a big room to reduce unnecessary prescribing for this condition.
The team notes that bringing states with above-average prescribing rates down to the average prescribing rate (24.1%) would result in 18,000 fewer opioid tablets being prescribed.
Similarly, reducing the number of tablets given with each prescription to the average (16 tablets) would result in 32,000 fewer tablets prescribed.
The study also found high-intensity prescriptions were associated with prolonged use not related to the original ankle sprain.
It supports guidelines and policies aimed at reducing the size of new, initial opioid prescriptions.
The researchers suggest that medical, surgical, and subspecialty societies should convene to propose best practices similar to the popular ‘Choosing Wisely’ campaign, acknowledging that pain management for most diagnoses can be accomplished with non-opioids.
In the end, the authors say the goal should be to maximize non-opioid alternatives for pain management of minor injuries and.
If opioids are absolutely necessary, patients should use the lowest initial dose possible, which should be no more than 10-12 tablets of common short-acting formulations.
The lead author M. Kit Delgado, MD, MS, is an assistant professor of Emergency Medicine and Epidemiology at Penn.
The study is published in the Annals of Emergency Medicine.
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Source: Annals of Emergency Medicine.