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Prescriptions for opioids and opioid-included polypharmacy: An analysis of the National Hospital Ambulatory Medical Care Survey

Jessica C. Rivera, MD, PhD


Objective: Opioid-associated complications are compounded by other concomitant drugs that affect the central nervous system (CNS). This analysis aims to describe opioid and CNS polypharmacy from a representative sample of emergency department (ED) encounters to identify patient- and facility-level characteristics associated with these prescription outcomes.

Design: Generalized linear regression multivariable modeling was used to test for associations between the prescription outcomes and individual and group level predictors.

Setting: Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for ED encounters from 2006-2015 were analyzed.

Participants: Survey entrants who received ED care within the above timeframe were analyzed.

Main outcomes: The primary outcomes were dichotomous variables of an opioid or CNS polypharmacy prescription.

Results: Twenty-five percent of encounters resulted in an opioid prescription plus another CNS medication prescription. Diagnoses of a blood disorder, musculoskeletal disorder or gastrointestinal disorder were associated with opioid prescription. Fifty-five percent of the presenting pain level treated with an opioid was reported as severe while 11 percent of opioid prescriptions were given to patients reporting no pain or mild pain. Non-Hispanic blacks had the lowest odds of receiving an opioid or CNS polypharmacy prescription compared to Non-Hispanic whites. Hospitals located within areas of increasing levels of poverty had decreasing odds of dispensing opioids following an ED encounter.

Conclusion: Opioid prescriptions resulted from one-quarter of ED encounters despite the acute care setting of the ED and included 11 percent frequency of prescription for patients reporting no pain or mild pain.


opioid prescribing, polypharmacy, acute care, emergency department

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