Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 150 No. 1516 (2020)

Prevalence and practice of opioid prescription at a Swiss emergency department: 2013–2017

  • Katharina Gaertner
  • Samuel Wildbolz
  • Victor Speidel
  • Aristomenis K. Exadaktylos
  • Wolf E. Hautz
  • Martin Müller
DOI
https://doi.org/10.4414/smw.2020.20202
Cite this as:
Swiss Med Wkly. 2020;150:w20202
Published
06.04.2020

Summary

AIMS OF THE STUDY

Addiction associated with prescription opioids is increasing worldwide, including Switzerland. We aimed (1) to determine whether the prevalence and incidence of opioid therapy at an emergency department (ED) in Switzerland has changed over five years and (2) to characterise consultations with incident opioid prescription.

METHODS

In this retrospective chart review, pre-existing opioid treatment and new prescriptions at the ED of Bern University Hospital “Inselspital”, Switzerland, between 2013 and 2017 were identified from the ED documentation system. Patients already taking opioids before presentation (prevalent opioid use) were distinguished from opioid-naïve patients who were prescribed opioids for the first time (incident opioid prescription) and relative numbers in every half year from 2013 to 2017 were calculated. Demographic and consultation characteristics were analysed to determine factors associated with incident opioid prescription.

RESULTS

Within the observation period, 199,299 patients consulted the ED. Of those, 4.95% (95% confidence interval [CI] 4.86–5.05, n = 9868) were using opioids on admission. Nearly 7.07% of them (95% CI 6.57–7.58, n = 698), 0.35% of the complete sample, were prescribed additional opioids. Incident opioid prescription for opioid-naïve patients was found in 2.26% of patients (95% 2.19–2.32, n = 4499). The relative number of prevalent opioid users did not show a significant (p = 0.163) association with time (categorised in half years) when adjusted for the potential confounders age group, trauma, the interaction of trauma and age group, other chief complaint, type of admission and time of admission. Incident opioid prescriptions significantly decreased over the study period (slope = −0.041% per half year, standard error = 0.012%, p = 0.007). The trend persisted after adjustment for the abovementioned potential confounders. Consultations resulting in opioid prescription were significantly associated with older age, musculoskeletal disorders and trauma (p <0.05).

CONCLUSIONS

Opioid prescriptions in a Swiss ED decreased between 2013 and 2017. Although this might be a sign of awareness of the risks of opioid prescription, the conclusion is derived from a single centre study and the observed trend warrants confirmation by data from other sources.

References

  1. Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165–9. doi:.https://doi.org/10.1053/ajem.2002.32643
  2. Degenhardt L, Charlson F, Ferrari A, Santomauro D, Erskine H, Mantilla-Herrara A, et al.; GBD 2016 Alcohol and Drug Use Collaborators. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5(12):987–1012. doi:.https://doi.org/10.1016/S2215-0366(18)30337-7
  3. Opioid deaths in the US: Findings from the Global Burden of Disease Study [Internet]. Institute for Health Metrics and Evaluation-IHME; 2019 [cited 2019 Jun 19]. Available from: http://www.healthdata.org/infographic/state-us-health-findings-global-burden-disease-study-gbd
  4. Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2020;75(1):13–7. doi:.https://doi.org/orgt/10.1016/j.annemergmed.2019.04.020
  5. Guy GP, Jr, Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697–704. doi:.https://doi.org/10.15585/mmwr.mm6626a4
  6. Hughes A, Williams MR, Lipari RN, Bose J, Copello EAP, Kroutil LA. Prescription drug use and misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Rev. 2016. Available from: https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm.
  7. World drug report 2018 [Internet]. United Nation Office of Drug and Crime: UNODC; 2019 [cited 2019 Jun 19]. Available from: https://www.unodc.org/wdr2018/prelaunch/WDR18_Booklet_2_GLOBAL.pdf
  8. Ruchat D, Suter MR, Rodondi PY, Berna C. Consommation d’opioïdes entre 1985 et 2015 : chiffres suisses et mise en perspective internationale [Opioid consumption from 1985 to 2015 : The situation in Switzerland, with an international comparison]. Rev Med Suisse. 2018;14(612):1262–6.
  9. Wertli MM, Reich O, Signorell A, Burgstaller JM, Steurer J, Held U. Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims. BMC Health Serv Res. 2017;17(1):167. doi:.https://doi.org/10.1186/s12913-017-2086-6
  10. Wertli MM, Held U, Signorell A, Steurer J, Blozik E, Burgstaller JM. Opioid Prescription in Switzerland: Appropriate Comedication use in Cancer and Noncancer Pain. Pain Physician. 2019;22(6):537–48.
  11. Rougemont-Bücking A, Grazioli VS, Marmet S, Daeppen JB, Lemoine M, Gmel G, et al. Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors. Eur J Psychotraumatol. 2018;9(1):1468706. doi:.https://doi.org/10.1080/20008198.2018.1468706
  12. Meisel ZF, Lupulescu-Mann N, Charlesworth CJ, Kim H, Sun BC. Conversion to Persistent or High-Risk Opioid Use After a New Prescription From the Emergency Department: Evidence From Washington Medicaid Beneficiaries. Ann Emerg Med. 2019;74(5):611–21. doi:.https://doi.org/10.1016/j.annemergmed.2019.04.007
  13. Exadaktylos AK, Hautz WE. Emergency Medicine in Switzerland. ICU Manag Pr. 2015;15.
  14. WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD index [Internet]. 2018 [cited 2019 May 16]. Available from: https://www.whocc.no/atc_ddd_index/
  15. University Hospital Bern. Inselspital. University Emergency Centre. Triage [Internet]. [cited 2019 Jun 19]. Available from: http://www.notfallzentrum.insel.ch/de/information-fuer-patienten/triage/
  16. Gmel G, Notari L, Gmel C. Suchtmonitoring Schweiz - Einnahme von psychoaktiven Medikamenten in der Schweiz im Jahr 2016. [Addiction Monitoring Switzerland - intake of psychoactive drugs in Switzerland in 2016]. Lausanne, Switzerland: Sucht Schweiz; 2018.
  17. Axeen S, Seabury SA, Menchine M. Emergency Department Contribution to the Prescription Opioid Epidemic. Ann Emerg Med. 2018;71(6):659–667.e3. doi:.https://doi.org/10.1016/j.annemergmed.2017.12.007
  18. Von Korff M, Saunders K, Thomas Ray G, Boudreau D, Campbell C, Merrill J, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008;24(6):521–7. doi:.https://doi.org/10.1097/AJP.0b013e318169d03b
  19. Voon P, Karamouzian M, Kerr T. Chronic pain and opioid misuse: a review of reviews. Subst Abuse Treat Prev Policy. 2017;12(1):36. doi:.https://doi.org/10.1186/s13011-017-0120-7
  20. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171(7):686–91. doi:.https://doi.org/10.1001/archinternmed.2011.117
  21. Dunn KM, Saunders K, Rutter CM, Banta-Green CJ, Merill JO, Sullivan MD, et al. Overdose and prescribed opioids: Associations among chronic non-cancer pain patients. Arch Intern Med. 2010;152(2):85–92. doi:https://doi.org/10.1059/0003-4819-152-2-201001190-00006
  22. Sullivan MD, Edlund MJ, Fan MY, Devries A, Brennan Braden J, Martin BC. Risks for possible and probable opioid misuse among recipients of chronic opioid therapy in commercial and medicaid insurance plans: The TROUP Study. Pain. 2010;150(2):332–9. doi:.https://doi.org/10.1016/j.pain.2010.05.020
  23. Glanz JM, Binswanger IA, Shetterly SM, Narwaney KJ, Xu S. Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy. JAMA Netw Open. 2019;2(4):e192613. doi:.https://doi.org/10.1001/jamanetworkopen.2019.2613
  24. Busse JW, Mahmood H, Maqbool B, Maqbool A, Zahran A, Alwosaibai A, et al. Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario. CMAJ Open. 2015;3(3):E324–30. doi:.https://doi.org/10.9778/cmajo.20140126
  25. Manchikanti L, Kaye AM, Knezevic NN, McAnally H, Slavin K, Trescot AM, et al. Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2017;20(2S):S3–92. doi:.https://doi.org/10.36076/ppj.2017.s92
  26. Knisely JS, Wunsch MJ, Cropsey KL, Campbell ED. Prescription Opioid Misuse Index: a brief questionnaire to assess misuse. J Subst Abuse Treat. 2008;35(4):380–6. doi:.https://doi.org/10.1016/j.jsat.2008.02.001
  27. Merrill JO, Von Korff M, Banta-Green CJ, Sullivan MD, Saunders KW, Campbell CI, et al. Prescribed opioid difficulties, depression and opioid dose among chronic opioid therapy patients. Gen Hosp Psychiatry. 2012;34(6):581–7. doi:.https://doi.org/10.1016/j.genhosppsych.2012.06.018
  28. Banta-Green CJ, Merrill JO, Doyle SR, Boudreau DM, Calsyn DA. Measurement of opioid problems among chronic pain patients in a general medical population. Drug Alcohol Depend. 2009;104(1-2):43–9. doi:.https://doi.org/10.1016/j.drugalcdep.2009.03.022

Most read articles by the same author(s)

<< < 1 2