Risk Factors for ER Visits in Chronic Opioid Users Identified

Headache, back pain, substance use disorder history tied to ER visits in those prescribed opioids
By Monica Smith
HealthDay Reporter

FRIDAY, Sept. 17 (HealthDay News) -- Use of Schedule II opioids, back pain, headache, and pre-existing substance use disorders are all associated with alcohol- or drug-related encounters (ADEs) and emergency department visits (EDVs) in adults who have taken prescribed opioids for at least 90 days, according to a study published in the Sept. 13 issue of the Archives of Internal Medicine.

Jennifer Brennan Braden, M.D., of the University of Washington School of Medicine in Seattle, and colleagues analyzed data on the use by adults with no cancer diagnosis of prescription opioids for at least 90 continuous days. They used regression analysis to look for risk factors for EDVs and ADEs within 12 months of opioid use. The study participants had Arkansas Medicaid or HealthCore commercial insurance.

The researchers found a significant association between EDVs and ADEs and preexisting substance use disorders, headache, and back pain; mental health problems were associated with EDVs in individuals enrolled in HealthCore and with ADEs in both HealthCore and Medicaid enrollees. Daily opioid use higher than 120 mg/d (morphine-equivalent) doubled the risk of ADEs, though daily opioid dose was not consistently linked to EDVs. Use of short-acting Drug Enforcement Agency Schedule II opioids was associated with EDVs, and use of Schedule II long-acting opioids was associated with ADEs.

"Use of Schedule II opioids, headache, back pain, and substance use disorders are associated with EDVs and ADEs among adults prescribed opioids for 90 days or more. It may be possible to increase the safety of chronic opioid therapy by minimizing the prescription of Schedule II opioids in these higher-risk recipients," the authors write.

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