Association Between In-Clinic Opioid Administration and Discharge Opioid Prescription in Urgent Care: a Retrospective Cohort Study

Journal of General Internal Medicine volume 36, pages43–50(2021)Cite this article

Abstract

Background

Emergency departments increasingly use nonopioid analgesics to manage acute pain and minimize opioid-related harms. Urgent care centers are expanding to lower costs and provide efficient access to healthcare. General internists increasingly work in these acute care settings. Much is known about opioid prescribing in the primary care, inpatient, and emergency department setting. Little is known about opioid prescribing in the urgent care setting and associated outcomes.

Objectives

To assess the association between in-clinic opioid administration and opioid receipt at clinic discharge and on progression to chronic opioid use among urgent care patients.

Design

Retrospective cohort study.

Participants

Patients, 20 years or older and not on opioid medications, who presented for care to an urgent care clinic within a safety-net healthcare system from June 1, 2016, to April 30, 2019.

Main Measures

We examined the association between the in-clinic administration of oral or intravenous opioids and opioid receipt at clinic discharge. We also examined the association between in-clinic opioid administration and progression to chronic opioid use after six months.

Key Results

The study sample included 34,978 patients, of which 13.8% (n = 4842) received in-clinic opioids and 86.2% (n = 30,136) did not receive in-clinic opioids. After adjusting for age, gender, race/ethnicity, insurance, and pain diagnosis, patients who received in-clinic opioids were more likely to receive opioids at discharge compared to patients who did not receive in-clinic opioids (aOR = 12.30, 95% CI 11.44–13.23). Among a selected cohort of patients, in-clinic opioid administration was associated with progression to chronic opioid use (aOR = 2.12, 95% CI 1.66–2.71).

Conclusions

In-clinic opioid administration was strongly associated with opioid receipt at discharge and progression to chronic opioid use. Increased use of nonopioid analgesics in urgent care could likely reduce this association and limit opioids available for diversion, overdose, and death.

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References

  1. 1.

    Deyo RA, Hallvik SE, Hildebran C, et al. Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study. J Gen Intern Med 2017;32(1):21-27.

    Article  Google Scholar 

  2. 2.

    Butler MM, Ancona RM, Beauchamp GA, et al. Emergency Department Prescription Opioids as an Initial Exposure Preceding Addiction. Ann Emerg Med 2016;68(2):202-208.

    Article  Google Scholar 

  3. 3.

    Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the Epidemic of Prescription Opioid Overdose Deaths. Am J Public Health 2018;108(4):500-502.

    Article  Google Scholar 

  4. 4.

    LaPietra AM. Alternatives to Opioids for Acute Pain Management in the Emergency Department: Part II. Emerg Med Rep. 2016;37(20).

  5. 5.

    Duncan RW, Smith KL, Maguire M, Stader DE. Alternatives to opioids for pain management in the emergency department decreases opioid usage and maintains patient satisfaction. Am J Emerg Med 2019;37(1):38-44.

    Article  Google Scholar 

  6. 6.

    Healthcare A Convenient care: growth and staffing trends in urgent care and retail medicine. In:2016.

  7. 7.

    Wang H, Robinson RD, Cowden CD, et al. Use of the SONET score to evaluate Urgent Care Center overcrowding: a prospective pilot study. BMJ Open 2015;5(4):e006860.

    Article  Google Scholar 

  8. 8.

    Weinick RM, Bristol SJ, DesRoches CM. Urgent care centers in the U.S.: findings from a national survey. BMC Health Serv Res. 2009;9:79.

    Article  Google Scholar 

  9. 9.

    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama 2016;315(15):1624-1645.

    CAS  Article  Google Scholar 

  10. 10.

    Herzig SJ, Mosher HJ, Calcaterra SL, Jena AB, Nuckols TK. Improving the safety of opioid use for acute non-cancer pain in hospitalized adults: a consensus statement from the Society of Hospital Medicine. J Hosp Med 2018;13(4):263.

    Article  Google Scholar 

  11. 11.

    Yeh BT. The controlled substances act: regulatory requirements. Congressional Research Service; 2012.

  12. 12.

    Administration USFaD. National Drug Code Directory. https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory. Updated 11/18/2019. Accessed 3 Dec 2019.

  13. 13.

    Vanderlip ER, Sullivan MD, Edlund MJ, et al. National study of discontinuation of long-term opioid therapy among veterans. Pain 2014;155(12):2673-2679.

    Article  Google Scholar 

  14. 14.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.

    CAS  Article  Google Scholar 

  15. 15.

    Calcaterra SL, Yamashita TE, Min SJ, Keniston A, Frank JW, Binswanger IA. Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use. J Gen Intern Med 2016;31(5):478-485.

    Article  Google Scholar 

  16. 16.

    Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff 2010;29(9):1630-1636.

    Article  Google Scholar 

  17. 17.

    Hsia RY, Friedman AB, Niedzwiecki M. Urgent care needs among nonurgent visits to the emergency department. JAMA Intern Med 2016;176(6):852-854.

    Article  Google Scholar 

  18. 18.

    Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015;372(3):241-248.

    Article  Google Scholar 

  19. 19.

    Warner M, Trinidad JP, Bastian BA, Minino AM, Hedegaard H. Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010-2014. Natl Vital Stat Rep 2016;65(10):1-15.

    PubMed  Google Scholar 

  20. 20.

    Heitz C, Morgenstern J, Bond C, Milne WK. Hot Off the Press: A Systematic Review And Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department. Acad Emerg Med Off J Soc Acad Emerg Med 2019;26(8):946-948.

    Article  Google Scholar 

  21. 21.

    Najjar M, Hall T, Estupinan B. Metoclopramide for Acute Migraine Treatment in the Emergency Department: An Effective Alternative to Opioids. Cureus 2017;9(4):e1181-e1181.

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    Todd KH. A Review of Current and Emerging Approaches to Pain Management in the Emergency Department. Pain Ther 2017;6(2):193-202.

    Article  Google Scholar 

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Author information

Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA

    Susan L. Calcaterra MD, MPH, Rachel M. Everhart PhD, MS, Lindsey E. Fish MD & Rebecca Hanratty MD

  2. Ambulatory Care Services, Denver Health Medical Center, Denver, CO, USA

    Yingbo Lou MS, Rachel M. Everhart PhD, MS, Lindsey E. Fish MD & Rebecca Hanratty MD

Authors
  1. Susan L. Calcaterra MD, MPH
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  2. Yingbo Lou MS
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  3. Rachel M. Everhart PhD, MS
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  4. Lindsey E. Fish MD
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  5. Rebecca Hanratty MD
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Corresponding author

Correspondence to Susan L. Calcaterra MD, MPH.

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Calcaterra, S.L., Lou, Y., Everhart, R.M. et al. Association Between In-Clinic Opioid Administration and Discharge Opioid Prescription in Urgent Care: a Retrospective Cohort Study. J GEN INTERN MED 36, 43–50 (2021). https://doi.org/10.1007/s11606-020-06059-8

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KEY WORDS

  • urgent care
  • opioids
  • acute pain