Emergency Department Opioid Prescribing Trends Among Provider Types: An Analysis of the NHAMCS, 2019-2021

Purpose: Despite efforts to mitigate the frequency in which opioids are prescribed, previous research has shown some change in this within emergency departments in the United States. However, few studies have investigated prescribing rates by provider types in these facilities. Thus, our primary objective was to assess opioid prescribing rates by differing members of the healthcare team using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS).

Methods: Using data from the 2019-2021 NHAMCS, we calculated the overall rates of opioids prescribed during an ED visit by provider type. Next, we estimated rates of opioids prescribed by provider type annually and determined differences across the years using design-based X2 tests and regression models.

Results: From 2019 through 2021, 7,428 of 50,548 visits had an opioid prescribed or administered, representing 15.62% of all ED visits. During this timeframe, the frequency of opioid prescriptions was highest among attending/consulting physicians occurring in 16.59% of total encounters. This was followed by physician assistants at 13.9%, nurse practitioners at 10.67%, and residents at 7.28%. Compared to 2019, rates of overall opioid prescription showed no significant changes over time; however, a significant decrease was seen among resident physicians, and a significant increase in any year was by RNs.

Discussion: From our analysis, rates of prescribing opioids in the ED were highest among attending or consulting physicians, though rates among physician assistants and nurse practitioners were higher than 10%. Resident physicians had a significant decrease in the number of visits in which opioids were prescribed, while RNs had an increase—likely due to new laws enacted during this timeframe. Removing barriers to alternative pain management for acute and long-term care may lessen rates of opioid prescriptions— including patient and provider training, inclusion of physical therapists, and incorporating osteopathic manipulative therapy within the ED.