Opioids Unnecessarily Prescribed for Minor Injury

The overprescribing of opioids has been a contributing factor to the numerous overdose-related deaths in the United States. Health experts have pointed to the varying prescribing habits for minor injuries, such as ankle sprains, which typically do not require opioids.

While taking opioids for a long period of time due to chronic pain is generally linked to a higher risk of misuse, new findings suggest that even brief use can increase the risk.

Patients who received a prescription for 30 or more opioid pills for a sprained ankle were observed to be more likely to fill an additional prescription for the drug within 6 months compared with those prescribed less than 15 pills, according to a study presented at the Society for Academic Emergency Medicine.

These findings highlight the need for the development of opioid prescribing guidelines for minor injuries in order to reduce unnecessary prescriptions, according to the study.

"The substantial variation in prescribing patterns of such extremely addictive medications for minor injuries results in many thousands of pills entering the community, and places patients at an increased risk of continued use and potentially addiction," said lead author M. Kit Delgado, MD, MS. "It's vital that we identify and understand the root causes of this growing issue."

Included in the study were insurance claims data for more than 53,000 patients visiting the emergency department for ankle sprains between 2011 and 2012. No patients included in the study filled an opioid prescription in the previous 6 months.

The investigators found that 7% of patients received an opioid prescription for pain management, but they noted significant variation in prescribing. Approximately 16% of patients in Mississippi received a prescription, while only 1.6% of patients in Delaware received the drugs.

The median number of pills prescribed was 20, but 5% received 60 or more, according to the study.

"Looking only at the cases analyzed in this study, if all prescriptions written for more than 20 pills were instead written for only 20, there would have been 37,721 fewer opioid pills entering the community," Dr Delgado said.

Controlling potentially unnecessary opioid prescribing for minor injuries may result in fewer patients developing opioid misuse disorder and less overdose-related deaths.

"If extrapolated more broadly to the treatment of other minor injuries, this likely translates to millions of highly addictive and unnecessary prescribed pain medications filtering into the community,” Dr Delgado said. “The study illustrates the potential benefit of laws to limiting new opioid prescriptions for acute pain to no more than five-day supply as was recently passed in New Jersey."

Since even a small number of opioids can increase the risk of long-term use, the authors advise providers to revise their prescribing habits, especially for minor injuries.

"An even more critical aspect of this study is that many would argue that opioids should not be prescribed for ankle sprain at all," said senior author Jeanmarie Perrone, MD. "Exposing young patients with an ankle sprain to opioids is unnecessary and risky. To limit the escalation of the opioid epidemic in this country, it's critical to keep these medications limited to patients whose injuries absolutely require them, and limit exposure to opioids for all other patients."