Rates and Predictors of Using Opioids in the Emergency Department to Treat Migraine in Adolescents and Young Adults

Objectives This study aimed to determine the rate and context in which opioids are used to treat migraine in adolescents and young adults seen in emergency care settings. Methods Data from 2010 to 2016 in the Cerner Health Facts electronic health record data warehouse were analyzed using multilevel logistic regression to estimate the population likelihood of an opioid being used in the emergency department (ED) to treat a primary diagnosis of migraine in adolescents and young adults and to evaluate the extent to which this likelihood varies as a function of characteristics of the patient (age, sex, race, and insurance), encounter (referral source, provider specialty, and encounter duration and year), and ED (region, setting, size, payer mix, and academic status). Results The study identified 14,494 eligible ED encounters with unique patients, of which 23% involved an opioid. Likelihood of being treated with opioids was significantly higher for patients who were older, female, white, and seen by a surgeon and who had longer encounters and encounters earlier in the time period sampled. Sites varied widely in percentage of encounters involving opioids (mean, 26.4% ± 20.1%; range, 0–100%), with higher rates associated with smaller sites with relatively higher proportions of commercially insured patients. Conclusions Use of opioids in the ED to treat migraine in youth is fairly common, with rate variation reflecting broader trends in for whom opioids tend to be more likely to be prescribed. These findings may be helpful for benchmarking and informing quality improvement efforts aimed at reducing unwarranted opioid exposure in youth.

[1]  J. Webber Center , 2011 .

[2]  E. Law,et al.  Associations Between Adolescent Chronic Pain and Prescription Opioid Misuse in Adulthood. , 2019, The journal of pain : official journal of the American Pain Society.

[3]  R. Hickey,et al.  A Modern Epidemic: Increasing Pediatric Emergency Department Visits and Admissions for Headache. , 2018, Pediatric neurology.

[4]  T. Palermo,et al.  Racial differences in opioid prescribing for children in the United States , 2018, Pain.

[5]  Ty S. Schepis,et al.  Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults. , 2018, Drug and alcohol dependence.

[6]  Vasa Curcin,et al.  Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse , 2018, Journal of medical Internet research.

[7]  R. Tremblay,et al.  Age of Cannabis Use Onset and Adult Drug Abuse Symptoms: A Prospective Study of Common Risk Factors and Indirect Effects , 2018, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[8]  David C. Sheridan,et al.  Relative Effectiveness of Dopamine Antagonists for Pediatric Migraine in the Emergency Department , 2016, Pediatric emergency care.

[9]  R. Hickey,et al.  Pediatric Emergency Department Visits for Headache 2007-2014: Frequency and Management Trends , 2018 .

[10]  J. Finkelstein,et al.  Multicenter prevalence of opioid medication use as abortive therapy in the ED treatment of migraine headaches , 2017, The American journal of emergency medicine.

[11]  Jeremiah D Schuur,et al.  The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio , 2017, Annals of emergency medicine.

[12]  T. Lancet The opioid crisis in the USA: a public health emergency , 2017, The Lancet.

[13]  Debra Houry,et al.  New Data on Opioid Use and Prescribing in the United States. , 2017, JAMA.

[14]  L. Cottler,et al.  Sex differences in prescription opioid use , 2017, Current opinion in psychiatry.

[15]  D. D. Des Jarlais,et al.  Past-year prevalence of prescription opioid misuse among those 11 to 30years of age in the United States: A systematic review and meta-analysis. , 2017, Journal of substance abuse treatment.

[16]  L. Hausmann,et al.  Comparison of Physician Implicit Racial Bias Toward Adults Versus Children. , 2017, Academic pediatrics.

[17]  Nancy D. Papesh,et al.  An Algorithm for Opioid and Barbiturate Reduction in the Acute Management of Headache in the Emergency Department , 2017, Headache.

[18]  Megan E. Patrick,et al.  Monitoring the Future national survey results on drug use, 1975-2017: Overview, key findings on adolescent drug use , 2016 .

[19]  Benjamin C. Sun,et al.  Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010. , 2016, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[20]  Jenna L. McCauley,et al.  Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update. , 2015, The American journal of psychiatry.

[21]  P. O'Malley,et al.  Prescription Opioids in Adolescence and Future Opioid Misuse , 2015, Pediatrics.

[22]  E. Loder,et al.  Survey of Opioid and Barbiturate Prescriptions in Patients Attending a Tertiary Care Headache Center , 2015, Headache.

[23]  Jonathan P. DeShazo,et al.  A comparison of a multistate inpatient EHR database to the HCUP Nationwide Inpatient Sample , 2015, BMC Health Services Research.

[24]  P. Borchgrevink,et al.  Use of prescribed opioids by children and adolescents: Differences between Denmark, Norway and Sweden , 2015, European journal of pain.

[25]  K. Kroenke,et al.  The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions. , 2015, The journal of pain : official journal of the American Pain Society.

[26]  P. Dalawari,et al.  Racial Differences in Opiate Administration for Pain Relief at an Academic Emergency Department , 2015, The western journal of emergency medicine.

[27]  E. Gallagher,et al.  Current management of migraine in US emergency departments: An analysis of the National Hospital Ambulatory Medical Care Survey* , 2015, Cephalalgia : an international journal of headache.

[28]  M. Neuman,et al.  A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department , 2015, Pediatrics.

[29]  E. Loder,et al.  The Prevalence and Burden of Migraine and Severe Headache in the United States: Updated Statistics From Government Health Surveillance Studies , 2015, Headache.

[30]  R. McHugh,et al.  Prescription drug abuse: from epidemiology to public policy. , 2015, Journal of substance abuse treatment.

[31]  David C. Lee,et al.  Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section. , 2014, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[32]  Alan Rosenberg,et al.  Opioid use among adolescent patients treated for headache. , 2014, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[33]  J. Pines,et al.  Trends in Prescription Opioid Use in Pediatric Emergency Department Patients , 2014, Pediatric emergency care.

[34]  Jesse M Pines,et al.  Rising opioid prescribing in adult U.S. emergency department visits: 2001-2010. , 2014, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[35]  Arlene E. Chung,et al.  Differential prescribing of opioid analgesics according to physician specialty for Medicaid patients with chronic noncancer pain diagnoses. , 2014, Pain research & management.

[36]  Brady T. West,et al.  Motives for medical misuse of prescription opioids among adolescents. , 2013, The journal of pain : official journal of the American Pain Society.

[37]  D. Mattson,et al.  The American Academy of Neurology's Top Five Choosing Wisely recommendations , 2013, Neurology.

[38]  Adam B. Cohen,et al.  The American Academy of Neurology's Top Five Choosing Wisely recommendations , 2013, Neurology.

[39]  J. Halterman,et al.  The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States , 2013, Journal of General Internal Medicine.

[40]  Ç. Wöber‐Bingöl,et al.  Epidemiology of Migraine and Headache in Children and Adolescents , 2013, Current Pain and Headache Reports.

[41]  S. Tepper Opioids Should Not Be Used in Migraine , 2012, Headache.

[42]  A. Greenwald,et al.  The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. , 2012, American journal of public health.

[43]  S. Feldon,et al.  Utilization, Diagnosis, Treatment and Cost of Migraine Treatment in the Emergency Department , 2009, Headache.

[44]  T. Ho,et al.  Impact of Recent Prior Opioid Use on Rizatriptan Efficacy. A Post Hoc Pooled Analysis , 2009, Headache.

[45]  A. N. Khan,et al.  Problems and barriers of pain management in the emergency department: Are we ever going to get better? , 2008, Journal of pain research.

[46]  Ling Zheng,et al.  Analysis of Headache Management in a Busy Emergency Room in the United States , 2008, Headache.

[47]  M. Pletcher,et al.  Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. , 2008, JAMA.

[48]  B. Rowe,et al.  Use of narcotic analgesics in the emergency department treatment of migraine headache , 2004, Neurology.

[49]  L. Johnston,et al.  Monitoring the Future national survey results on drug use, 1975-2018: Volume II, college students and adults ages 19-60 , 2005 .

[50]  Anthony S. Bryk,et al.  Hierarchical Linear Models: Applications and Data Analysis Methods , 1992 .

[51]  Aditi Saxena,et al.  The Emergency Department , 2010 .