Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 May;20(3):428-432.
doi: 10.5811/westjem.2019.3.39311. Epub 2019 Apr 16.

Variations in Opioid Prescribing Behavior by Physician Training

Evan L Leventhal  1 , Larry A Nathanson  1 , Alden M Landry  1
Affiliations

Variations in Opioid Prescribing Behavior by Physician Training

Evan L Leventhal et al. West J Emerg Med. 2019 May.

Abstract

Introduction: Opioid abuse has reached epidemic proportions in the United States. Patients often present to the emergency department (ED) with painful conditions seeking analgesic relief. While there is known variability in the prescribing behaviors of emergency physicians, it is unknown if there are differences in these behaviors based on training level or by resident specialty.

Methods: This is a retrospective chart review of ED visits from a single, tertiary-care academic hospital over a single academic year (2014-2015), examining the amount of opioid pain medication prescribed. We compared morphine milligram equivalents (MME) between provider specialty and level of training (emergency medicine [EM] attending physicians, EM residents in training, and non-EM residents in training).

Results: We reviewed 55,999 total ED visits, of which 4,431 (7.9%) resulted in discharge with a prescription opioid medication. Residents in a non-EM training program prescribed higher amounts of opioid medication (108 MME, interquartile ratio [IQR] 75-150) than EM attendings (90 MME, lQR 75-120), who prescribed more than residents in an EM training program (75 MME, IQR 60-113) (p<0.01).

Conclusion: In an ED setting, variability exists in prescribing patterns with non-EM residents prescribing larger amounts of opioids in the acute setting. EM attendings should closely monitor for both over- and under-prescribing of analgesic medications.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Most common chief complaints. Back pain was the most common chief complaint for which an opioid prescription was written. Combined, the top 15 chief complaints accounted for 52% of the opioid prescriptions.
Figure 2
Figure 2
Total morphine milligram equivalent per patient by prescriber group. Quantity of opioids prescribed in morphine milligram equivalent (MME) by each group of providers. Gray box shows the median and interquartile range, while the whisker lines represent the 95th percentile. EM, emergency medicine; mg, milligram.
See this image and copyright information in PMC

References

    1. Warner M, Chen LH, Makuc DM, et al. Drug poisoning deaths in the United States, 1980–2008. NCHS Data Brief. 2011;81:1–8. - PubMed
    1. Jones CM, Mack KA, Paulozzi LJ. Pharmaceutical overdose deaths, United States, 2010. JAMA. 2013;309(7):657–9. - PubMed
    1. Volkow ND, McLellan TA, Cotto JH, et al. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305(13):1299–301. - PMC - PubMed
    1. Cordell WH, Keene KK, Giles BK, et al. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002;20(3):165–9. - PubMed
    1. Mazer-Amirshahi M, Mullins PM, Rasooly I, et al. Rising opioid prescribing in adult U.S. emergency department visits: 2001–2010. Acad Emerg Med. 2014;21(3):236–43. - PubMed

MeSH terms