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Original research
Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis
  1. Bertram K Woitok1,
  2. Petra Büttiker1,
  3. Svenja Ravioli1,
  4. Georg-Christian Funk2,
  5. Aristomenis K Exadaktylos3,
  6. Gregor Lindner1
  1. 1Department of Internal and Emergency Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
  2. 2Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Wilhelminenspital, Vienna, Austria
  3. 3Department of Emergency Medicine, Inselspital Bern, Bern, Switzerland
  1. Correspondence to Dr Bertram K Woitok; bertram.woitok{at}spital.so.ch

Abstract

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.

  • accident & emergency medicine
  • pain management
  • internal medicine
http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors BW and GL had the idea for the study and prepared the study protocol. BW, PB and SR performed data mining and created the research database. G-CF supervised the data quality and performed statistical analysis. BW and GL wrote the manuscript draft. BW, GL, PB, SR, G-CF and AKE critically reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved, and the need to acquire informed consent from individual patients waived by the Ethics Committee Nordwest und Zentralschweiz (www.eknz.ch, Project ID 2019–01654).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. No additional data available.

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