The share from emergency departments declined from 7 percent to 4 percent in that same time, the study finds.

Prescriptions for opioid painkillers increased 471 percent from 1996 to 2012, according to a new Annals of Emergency Medicine study, “Emergency Department Contribution to the Prescription Opioid Epidemic.”

But emergency departments are not a major source of prescriptions. In fact, their share of opioid prescribing is small and declining.

The share from doctor’s offices prescriptions rose from 71 percent to 83 percent during the 17 years analyzed. The share from emergency departments declined from 7 percent to 4 percent in that same time, the study finds.

The analysis was based on the nationally representative Medical Expenditure Panel Survey data, administered to 15,000 patients annually.

“Emergency departments are at the forefront of efforts to reduce harm associated with opioid abuse, but they are not a major source of opioid prescriptions,” said Sarah Axeen, Assistant Professor of Emergency Medicine, Keck School of Medicine, University of Southern California and lead study author.

“Policymakers and providers should match interventions with settings where they are most likely to be successful. Efforts to reduce the quantity of opioid prescriptions should focus less on hospital-based prescribing and more on doctor’s office-based prescribing practices, specifically addressing refills or chronic prescriptions,” she said.

Most patients receive opioid prescriptions from other sources. A typical patient obtained 44 percent of his or her opioids from office-based prescriptions, 26 percent from dental or other outpatient sources, 16 percent from emergency departments and 14 percent from inpatient settings.

More growth was seen in refills than one-time prescriptions. Opioid prescription refills originating from a doctor’s office increased 446 percent while one-time prescriptions increased 277 percent during the period examined.

Contrary to popular belief, emergency departments are not disproportionately issuing prescriptions to high-risk opioid users. In fact, high-risk opioid users (the top 5 percent of annual opioid consumption) received just 2.4 percent of their opioids from the emergency department compared with 87.8 percent from office visits, the study found.

While opioid prescriptions from the ER are still trending up, the level of existing oversight can make interventions more feasible and more successful than many other points of care, the authors note.

The most effective strategies, the authors assert, to address the opioid epidemic would include intensifying screening efforts, developing or supporting referral networks and encouraging interventions for high risk patient. 

“Emergency physicians can best help address our nation’s opioid epidemic by focusing on the development and dissemination of tools that help providers identify high-risk individuals and refer them to treatment,” said Axeen.

The full study is available here.

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. For more, visit www.acep.org.