Opioid use and prescription in emergency departments visits in Taiwan: a nationwide population-based retrospective study

The emergency departments (EDs) prescribed opioids in acute pains and had thus been one of its major sources. We aimed to describe the features of EDs opioid use in Taiwan from 2008 to 2018. A retrospective cross-sectional study was conducted through Taiwan’s National Health Insurance Database. The patients having an index EDs visit from 2008 to 2018 were identified who had been administered or prescribed opioid at discharge. The general trend and the trend for each type of opioid prescribed from EDs in Taiwan were explored along with the diagnosis resulting in opioid prescriptions in EDs. The opioid prescription from EDs in the study period accounted for 9.72% to 11.97%of the total opioid prescriptions in Taiwan. The rate (prescriptions per 104 persons) of opioids prescription in EDs peaked from 282.64/104 in 2008 to 330.24/104 in 2015, and declined to 286.47/104 in 2018. The pethidine prescription rate had downward trend from 123.05/104 in 2008 to 23.69/104 in 2018 in EDs. Morphine was the most administered opioid in 2009 (121.11/104) which increased to 180.99/104 in 2018. The reasons for opioid prescriptions in EDs were the abdominal pain followed by chest pain, respiratory discomfort and cancer-related pain. It was noted that EDs prescriptions of morphine, codeine and fentanyl had an increasing trend in Taiwan between 2008 to 2018, while pethidine had a declining trend. Morphine was the most used and prescribed opioid in EDs, and the leading cause for opioid usage was abdominal pains.

Emergency departments; Opioids; Trend; Prescription

[1] Young Ii HW, Jean N, Tyndall JA, Cottler LB. Evaluating the risk of prescription opioid misuse among adult emergency department patients. Emergency Medicine International. 2022; 2022: 1282737.

[2] Rech MA, Griggs C, Lovett S, Motov S. Acute pain management in the emergency department: use of multimodal and non-opioid analgesic treatment strategies. The American Journal of Emergency Medicine. 2022; 58: 57–65.

[3] Preuss CV, Kalava A, King KC. Prescription of controlled substances: benefits and risks. StatPearls: Treasure Island. 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537318/ (Accessed: 19 June 2023).

[4] Keefe FJ. Managing acute pain with opioids in the emergency department: a teachable moment? American Journal of Public Health. 2022; 112: S9–S11.

[5] Lovegrove MC, Dowell D, Geller AI, Goring SK, Rose KO, Weidle NJ, et al. Us emergency department visits for acute harms from prescription opioid use, 2016–2017. American Journal of Public Health. 2019; 109: 784–791.

[6] Baiden P, Eugene DR, Nicholas JK, Spoor S, Brown FA, LaBrenz CA. Misuse of prescription opioids and suicidal behaviors among Black adolescents: findings from the 2017 and 2019 youth risk behavior survey. Journal of Racial and Ethnic Health Disparities. 2023; 10: 1856–1868.

[7] Shi HJ, Zhang XP, Hai C, Shi W, Wang P, Hu AM. Opioids increase the risk of delirium in critically ill patients: a propensity score analysis. International Journal of Clinical Pharmacology and Therapeutics. 2023; 61: 289–296.

[8] Carter MW, Yang BK, Davenport M, Kabel A. Increasing rates of opioid misuse among older adults visiting emergency departments. Innovation in Aging. 2019; 3: igz002.

[9] Rosenblum A, Parrino M, Schnoll SH, Fong C, Maxwell C, Cleland CM, et al. Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug and Alcohol Dependence. 2007; 90: 64–71.

[10] Mazer-Amirshahi M, Mullins PM, Rasooly I, van den Anker J, Pines JM. Rising opioid prescribing in adult U.S. emergency department visits: 2001–2010. Academic Emergency Medicine. 2014; 21: 236–243.

[11] Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. The New England Journal of Medicine. 2017; 376: 663–673.

[12] Meisel ZF, Lupulescu-Mann N, Charlesworth CJ, Kim H, Sun BC. Conversion to persistent or high-risk opioid use after a new prescription from the emergency department: evidence from Washington Medicaid beneficiaries. Annals of Emergency Medicine. 2019; 74: 611–621.

[13] Ibrahim AR, Elgamal ME, Moursi MO, Shraim BA, Shraim MA, Shraim M, et al. The association between early opioids prescribing and the length of disability in acute lower back pain: a systematic review and narrative synthesis. International Journal of Environmental Research and Public Health. 2022; 19: 12114.

[14] Pattullo GG. Opioids in acute pain: towards getting the right balance. Anaesthesia and Intensive Care. 2022; 50: 68–80.

[15] Santo L, Schappert SM. Opioids prescribed to adults at discharge from emergency departments: United States, 2017–2020. National Center for Health Statistics Data Brief. 2023; 1–8.

[16] Cantrill SV, Brown MD, Carlisle RJ, Delaney KA, Hays DP, Nelson LS, et al. Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department. Annals of Emergency Medicine. 2012; 60: 499–525.

[17] Bavarian R, Sandhu S, Handa S, Shaefer J, Kulich RA, Keith DA. Centers for disease control and prevention clinical practice guideline for prescribing opioids: United States, 2022. Journal of the American Dental Association. 2023; 154: 849–855.

[18] Elder JW, Gu Z, Kim J, Moulin A, Bang H, Parikh A, et al. Assessing local California trends in emergency physician opioid prescriptions from 2012 to 2020: experiences in a large academic health system. American Journal of Emergency Medicine. 2022; 51: 192–196.

[19] Woitok BK, Büttiker P, Ravioli S, Funk G, Exadaktylos AK, Lindner G. Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis. BMJ Open. 2020; 10: e038079.

[20] Stanley B, Collins LJ, Norman AF, Karro J, Jung M, Bonomo YA. Opioid prescribing in the emergency department of a tertiary hospital: a retrospective audit of hospital discharge data. Emergency Medicine Australasia. 2020; 32: 33–38.

[21] Gaertner K, Wildbolz S, Speidel V, Exadaktylos AK, Hautz WE, Muller M. Prevalence and practice of opioid prescription at a Swiss emergency department: 2013–2017. Swiss Medical Weekly. 2020; 150: w20202.

[22] Gisev N, Buizen L, Hopkins RE, Schaffer AL, Daniels B, Bharat C, et al. Five-year trajectories of prescription opioid use. JAMA Network Open. 2023; 6: e2328159.

[23] Häuser W, Buchser E, Finn DP, Dom G, Fors E, Heiskanen T, et al. Is Europe also facing an opioid crisis?—A survey of European pain federation chapters. European Journal of Pain. 2021; 25: 1760–1769.

[24] Camilloni A, Nati G, Maggiolini P, Romanelli A, Carbone G, Giannarelli D, et al. Chronic non-cancer pain in primary care: an Italian cross-sectional study. Signa Vitae. 2021; 17: 54–62.

[25] Cho NR, Chang YJ, Lee D, Kim JR, Ko DS, Choi JJ. Trends in opioid prescribing practices in South Korea, 2009–2019: are we safe from an opioid epidemic? PLOS ONE. 2021; 16: e0250972.

[26] Huang Z, Su X, Diao Y, Liu S, Zhi M, Geng S, et al. Clinical consumption of opioid analgesics in China: a retrospective analysis of the national and regional data 2006–2016. Journal of Pain and Symptom Management. 2020; 59: 829–835.e1.

[27] Liu X, Luo C, Dai H, Fang W. Consumption trends and prescription patterns of opioids from 2011 to 2016: a survey in a Chinese city. BMJ Open. 2019; 9: e021923.

[28] Wei Y, Zhao J, Wong IC, Wan EY, Taylor DM, Blais JE, et al. Relation of substance use disorders to mortality, accident and emergency department attendances, and hospital admissions: a 13-year population-based cohort study in Hong Kong. Drug and Alcohol Dependence. 2021; 229: 109119.

[29] Taylor J, Pardo B, Hulme S, Bouey J, Greenfield V, Zhang S, et al. Illicit synthetic opioid consumption in Asia and the Pacific: assessing the risks of a potential outbreak. Drug and Alcohol Dependence. 2021; 220: 108500.

[30] Wang TH, Tsai YT, Lee PC. Health big data in Taiwan: a national health insurance research database. Journal of the Formosan Medical Association. 2023; 122: 296–298.

[31] Taiwan Food and Drug Administration. Classification and items of controlled drugs. Taiwan: Taiwan Food and Drug Administration. 2021. Available at: http://www.fda.gov.tw/tc/includes/GetFile.ashx?id=f637595522617619465 (Assessed: 19 June 2023).

[32] Taiwan Food and Drug Administration. Guidelines and regulations for clinicians long-term prescribing narcotic analgesics to patients with non-cancer chronic intractable pain. Taiwan: Taiwan Food and Drug Administration. 2021. Available at: http://www.fda.gov.tw/tc/includes/GetFile.ashx?id=f637467465612177011 (Accessed: 19 June 2023).

[33] Yang BK, Storr CL, Trinkoff AM, Sohn M, Idzik SK, McKinnon M. National opioid prescribing trends in emergency departments by provider type: 2005–2015. American Journal of Emergency Medicine. 2019; 37: 1439–1445.

[34] Naavaal S, Kelekar U. Opioid prescriptions in emergency departments: findings from the 2016 national hospital ambulatory medical care survey. Preventive Medicine. 2020; 136: 106035.

[35] Chen TC, Wang TC, Lin CP, Bonar K, Ashcroft DM, Chan KA, et al. Increasing tramadol utilisation under strict regulatory control of opioid prescribing—a cross-sectional study in Taiwan from 2002 through 2016. Journal of the Formosan Medical Association. 2021; 120: 810–818.

[36] Yasaei R, Rosani A, Saadabadi A. Meperidine. StatPearls: Treasure Island. 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470362/ (Accessed: 19 June 2023).

[37] Pan HH, Li CY, Lin TC, Wang JO, Ho ST, Wang KY. Trends and characteristics of pethidine use in Taiwan: a six-year-long survey. Clinics. 2012; 67: 749–755.

[38] Felden L, Walter C, Harder S, Treede RD, Kayser H, Drover D, et al. Comparative clinical effects of hydromorphone and morphine: a meta-analysis. British Journal of Anaesthesia. 2011; 107: 319–328.

[39] Kang KH, Kuo LF, Cheng IC, Chang CS, Tsay WI. Trends in major opioid analgesic consumption in Taiwan, 2002–2014. Journal of the Formosan Medical Association. 2017; 116: 529–535.

[40] Pinyao Rui, Loredana Santo, Jill J Ashman. Trends in opioids prescribed at discharge from emergency departments among adults: United States, 2006–2017. National Health Statistics Reports. 2020; 1–12.