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. 2021 Aug 30;22(5):1067-1075.
doi: 10.5811/westjem.2021.5.52378.

Positive Toxicology Results Are Not Associated with Emergency Physicians' Opioid Prescribing Behavior

Jonathan B Lee  1 , Ghadi Ghanem  1 , Soheil Saadat  1 , Justin Yanuck  1 , Brent Yeung  2 , Bharath Chakravarthy  1 , Ariana Nelson  2 , Shalini Shah  2
Affiliations

Positive Toxicology Results Are Not Associated with Emergency Physicians' Opioid Prescribing Behavior

Jonathan B Lee et al. West J Emerg Med. .

Abstract

Introduction: Given the general lack of literature on opioid and naloxone prescribing guidelines for patients with substance use disorder, we aimed to explore how a physician's behavior and prescribing habits are altered by knowledge of the patient's concomitant use of psychotropic compounds as evident on urine and serum toxicology screens.

Methods: We conducted a retrospective chart review study at a tertiary, academic, Level I trauma center between November 2017-October 2018 that included 358 patients who were discharged from the emergency department (ED) with a diagnosis of fracture, dislocation, or amputation and received an opioid prescription upon discharge. We extracted urine and serum toxicology results, number and amount of prescription opioids upon discharge, and the presence of a naloxone script.

Results: The study population was divided into five subgroups that included the following: negative urine and serum toxicology screen; depressants; stimulants; mixed; and no toxicology screens. When comparing the 103 patients in which toxicology screens were obtained to the 255 patients without toxicology screens, we found no statistically significant differences in the total prescribed morphine milligram equivalent (75.0 and 75.0, respectively) or in the number of pills prescribed (15.0 and 13.5, respectively). Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge.

Conclusion: Our study found no association between positive urine toxicology results for psychotropically active substances and the rates of opioid prescribing within a single-center, academic ED. Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. More research on the associations between illicit drug use, opioids, and naloxone prescriptions is necessary to help establish guidelines for high-risk patients.

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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
Study enrollment and exclusion November 2017–October 2018. Recruitment, enrollment, and exclusion of subjects. Flowchart indicates the study population and its categorization into the four groups: negative tox screen; positive for stimulants; “mixed”; and for depressants. In cases where the ED administered drugs known to affect the results of urine toxicology screens, patients were deemed presumptively negative for that substance and recategorized. † Opioid + refers to the number of patients who had opioids on urine toxicology screens that could not be explained by a prior opioid prescription or ED administration of an opioid.
Figure 2
Figure 2
The median total morphine milligram equivalents across drug classes. There was no statistically significant difference in the median total morphine milligram equivalent between the five subgroups (p=0.074). * Represents outliers. MME, morphine milligram equivalent.
Figure 3
Figure 3
The median total amount of medications prescribed across drug classes. There was no statistically significant difference in the median number of pills between the five subgroups (P = 0.684). *represents outliers. UToX, urine toxicology screen.
See this image and copyright information in PMC

References

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