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The Path to Opioid Addiction May Start in the Emergency Room

For every 48 people who get a new opioid painkiller prescription in the emergency room, one will end up on long-term narcotic therapy, a new study finds.

By Francie Diep


(Photo: Michael B./Flickr)

How often does a prescription for an opioid painkiller turn deadly?

That’s the question on a lot of doctors’ minds right now as they try to curb prescriptions for painkillers, like OxyContin or Percocet, in hopes that doing so will reduce opioid addiction and overdoses in America. An estimated 1.9 million Americans have an opioid use disorder; last year, the number of Americans who died from prescription painkiller and heroin overdoses surpassed that of gun homicide deaths.

Now, a new study offers evidence that, sometimes, the path to addiction may start in the emergency room (ER). People who were seen by ER doctors who tend to give out more opioid prescriptions were also more likely to get a long-term opioid prescription later that year, a team of health-policy researchers from Harvard University found. The numbers in the new study suggest that, for every 48 people who get a new narcotic prescription in the ER, one will end up on a long-term painkiller regimen. That’s worrisome given research that suggests people who get months-long opioid scripts are more likely than people who never take narcotic painkillers to be diagnosed with opioid dependence or addiction.

In other words, for some, an emergency-room prescription may be one small step toward a substance use disorder. Certainly the vast majority of people who receive new opioid prescriptions don’t become addicted. But the more prescriptions doctors give out, the more likely they’ll end up handing a script to someone who will have a serious problem later. Between 1991 and 2011, the number of hydrocodone and oxycodone prescriptions retail pharmacies filled nearly tripled, reaching 219 million. It’s only in the last few years that those numbers have begun falling again. The new study lends credence to emergency departments that are trying to cut down their opioid prescriptions, a trend that the health news site STAT reported on last month.

To link prescribing practices and long-term prescriptions, three Harvard researchers mined a database of more than 300,000 Americans who went to the emergency room sometime between 2008 and 2011, and used Medicare to pay for it. The people in the study had been prescribed opioid painkillers while in the ER and didn’t already have an existing prescription any time in the last six months. The researchers split up the patient files between those who were cared for by a doctor who often gave out opioid prescriptions, versus one who infrequently wrote such scripts.

Overall, few patients went on a long-term opioid prescription — lasting six months or more — within a year of that fateful ER visit. But it happened more among those who were treated by high-prescribing doctors. The more intense a doctor’s opioid-prescribing habit was, the more likely her patients were to get a long-term script later. Meanwhile, the patients of low-prescribing doctors didn’t seem to suffer for their more modest pill supplies: Their rates of returning to the hospital for the same diagnosis were the same as the rates of patients of high-prescribing doctors.

The causes of addiction are complex. Cutting down on unnecessary prescriptions is just one tool America will have to use to combat its opioid epidemic — but it’s an important one.