Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic

Tucker Lurie¹, Naomi Bonnin², Jeffrey Rea³, Gurshawn Tuteja⁴, Zachary Dezman⁵, R Gentry Wilkerson⁶, Adelina Buganu⁷, Rose Chasm⁸, Daniel J Haase⁹, Quincy K Tran¹⁰

Affiliations

¹ Wellspan York Hospital, Department of Emergency Medicine, 1001 South George Street, York, PA, 17403, USA. Electronic address: tlurie@wellspan.org.
² University of Maryland Global Campus, 1616 McCormick Dr, Largo, MD 20774, USA.
³ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA. Electronic address: jrea@umm.edu.
⁴ Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA. Electronic address: GTUTEJA@augusta.edu.
⁵ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: ZDezman@som.umaryland.edu.
⁶ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: Gwilkerson@som.umaryland.edu.
⁷ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
⁸ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: Rchasm@som.umaryland.edu.
⁹ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA. Electronic address: DHaase@som.umaryland.edu.
¹⁰ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA. Electronic address: Qtran@som.umaryland.edu.

PMID: 35367681
PMCID: PMC8956353
DOI: 10.1016/j.ajem.2022.03.040

Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic

Tucker Lurie et al. Am J Emerg Med. 2022 Jun.

. 2022 Jun:56:63-70.

doi: 10.1016/j.ajem.2022.03.040. Epub 2022 Mar 26.

Authors

Tucker Lurie¹, Naomi Bonnin², Jeffrey Rea³, Gurshawn Tuteja⁴, Zachary Dezman⁵, R Gentry Wilkerson⁶, Adelina Buganu⁷, Rose Chasm⁸, Daniel J Haase⁹, Quincy K Tran¹⁰

Affiliations

¹ Wellspan York Hospital, Department of Emergency Medicine, 1001 South George Street, York, PA, 17403, USA. Electronic address: tlurie@wellspan.org.
² University of Maryland Global Campus, 1616 McCormick Dr, Largo, MD 20774, USA.
³ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA. Electronic address: jrea@umm.edu.
⁴ Medical College of Georgia, 1120 15th St, Augusta, GA 30912, USA. Electronic address: GTUTEJA@augusta.edu.
⁵ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: ZDezman@som.umaryland.edu.
⁶ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: Gwilkerson@som.umaryland.edu.
⁷ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
⁸ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: Rchasm@som.umaryland.edu.
⁹ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA. Electronic address: DHaase@som.umaryland.edu.
¹⁰ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA. Electronic address: Qtran@som.umaryland.edu.

PMID: 35367681
PMCID: PMC8956353
DOI: 10.1016/j.ajem.2022.03.040

Abstract

Introduction: The COVID-19 pandemic was superimposed upon an ongoing epidemic of opioid use disorder and overdose deaths. Although the trend of opioid prescription patterns (OPP) had decreased in response to public health efforts before the pandemic, little is known about the OPP from emergency department (ED) clinicians during the COVID-19 pandemic.

Methods: We conducted a pre-post study of adult patients who were discharged from 13 EDs and one urgent care within our academic medical system between 01/01/2019 and 09/30/2020 using an interrupted time series (ITS) approach. Patient characteristics and prescription data were extracted from the single unified electronic medical record across all study sites. Prescriptions of opioids were converted into morphine equivalent dose (MED). We compared the "Covid-19 Pandemic" period (C19, 03/29/2020-9/30/2020) and the "Pre-Pandemic" period (PP, 1/19/2020-03/28/2020). We used a multivariate logistic regression to assess clinical factors associated with opioid prescriptions.

Results: We analyzed 361,794 ED visits by adult patients, including 259,242 (72%) PP and 102,552 (28%) C19 visits. Demographic information and percentages of patients receiving opioid prescriptions were similar in both groups. The median [IQR] MED per prescription was higher for C19 patients (70 [56-90]) than for PP patients (60 [60-90], P < 0.001). ITS demonstrated a significant trend toward higher MED prescription per ED visit during the pandemic (coefficient 0.11, 95% CI 0.05-0.16, P = 0.002). A few factors, that were associated with lower likelihood of opioid prescriptions before the pandemic, became non-significant during the pandemic.

Conclusion: Our study demonstrated that emergency clinicians increased the prescribed amount of opioids per prescription during the COVID-19 pandemic compared to the pre-pandemic period. Etiologies for this finding could include lack of access to primary care and other specialties during the pandemic, or lower volumes allowing for emergency clinicians to identify who is safe to be prescribed opioids.

Keywords: COVID-19 pandemic; Interrupted time series; Opioid prescriptions.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts to disclose.

Figures

**Fig. 1**
Patient Selection Diagram, patients' index visits, University of Maryland Medical System (UMMS) (January 01, 2019, and September 30, 2020).

**Fig. 2**
Interrupted time series for total morphine equivalent dose prescribed per Emergency Department visit, week to week, University of Maryland Medical System (UMMS) (January 01, 2019, and September 30, 2020).

**Fig. 3**
Comparison of predictors' statistically significant coefficients associated with likelihood of opioid prescriptions before or after the onset of the 2020 coronavirus pandemic. 3A. Comparison of predictors with higher likelihood of opioid prescription (positive coefficients) before the pandemic with the same predictors' coefficient for patients who presented to EDs during the pandemic. Higher positive coefficients indicated higher likelihood. Abbreviations: ED, emergency department; ESI, Emergency Severity Index. 3B. Comparison of predictors with lower likelihood of opioid prescription (negative coefficients) before the pandemic with the same predictors' coefficient for patients who presented to EDs during the pandemic. More negative coefficients demonstrated lower likelihood of opioid prescription. Coefficients from non-statistically significant predictors were assigned a value of zero for illustration. ^#Coefficient changed from non-statistically significant before pandemic to lower likelihood of opioid prescription during the pandemic. ^⁎Coefficient changed from lower likelihood for opioid prescription before the pandemic to non-statistically significant during the pandemic. Abbreviations: ED, emergency department; ESI, Emergency Severity Index.

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References

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Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic

Affiliations

Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Medical

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