Opioid Abuse in the Emergency Department

Background T he last decade has witnessed a dramatic shift in the perception of the safety of opioid prescribing. An initial analysis by the Pain and Policy Studies Group at the University of Wisconsin Medical School1 concluded that the use of opioids in the chronic pain population carried a low risk of abuse potential. They had studied the national utilization of five opioid analgesics used to treat severe pain along with a retrospective chart review of ED visits associated with abusive behaviors. From 1990 to 1996, there were increases in medical use of morphine (+59%), fentanyl (+1168%), oxycodone (+23%), and hydromorphone (+19%), and a decrease in the medical use of meperidine (-35%). During the same period, the total number of hospital emergency department admissions (resulting from drug abuse) per year due to opioid analgesics increased from 32,430 to 34,563 (6.6%), but the proportion of admissions for opioid abuse relative to total mentions for drug abuse decreased from 5.1% to 3.8%. The authors concluded that the trend of increasing medical use of opioid analgesics to treat pain did not appear to contribute to an increase in opioid analgesic abuse. But a subsequent epidemiologic study, the 2002 National Survey on Drug Use and Health,2 revealed that the number of people using prescription opioids for nonmedical purposes (defined as use of prescription-type drugs not prescribed for the survey respondent by a physician or used only for the experience or psychomimetic feeling) increased significantly after 1996, the final year of data collection of the aforementioned Pain and Policy Studies Group report (Fig 1). In fact, by 2002, the prevalence of prescription opioid abuse surpassed that of cocaine and heroin and became second only to marijuana in terms of past year illicit drug dependence or abuse (Fig 2). In the recent past, high-visibility press coverage of prescription opioid addiction has cast a bright light on the complexity of prescribing opioids. By the spring of 2004, federal agencies including the Food and Drug Administration (FDA), the Drug Enforcement Administration (DEA) and the White House Office of National Drug Policy launched coordinated prescription drug abuse prevention initiatives that emphasized edPrescription Opioid Abuse in the Emergency Department