Emergency Department Visits Among Recipients of Chronic Opioid Therapy

Abstract

Chronic opioid therapy (COT) is now a common strategy for managing chronic noncancer pain (CNCP).^1-3 Concurrent with an increase in COT for CNCP has been an increase in reported opioid abuse and deaths from prescription opioid overdose. In Washington state, an increase in overdose deaths among individuals receiving workers' compensation benefits was observed between 1996 and 2002, concurrent with a shift toward the use of more potent Schedule II opioids and a 50% increase in average daily morphine dose.⁴ Similar increases in opioid-related fatal poisoning rates have been found in Massachusetts⁵ and in Oregon.⁶ Nonfatal adverse events resulting from prescription opioid use also appear to be increasing. The Centers for Disease Control⁷ estimates that the number of emergency department (ED) visits for nonmedical use of opioid analgesics increased 111% from 2004 to 2008 (from 144 600 to 305 900 visits) and increased 29% just during the 2007-2008 period. Oxycodone, hydrocodone, and methadone were most frequently noted, and the use of all of these showed statistically significant increases.