(171) U.S. Emergency Department Visits for Prescription Opioid Adverse Events in Older Adults, 2016 to 2018

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 845

Poster Presenter(s)

Mingfeng Zhang, PhD
– US Food and Drug Administration, Silver Spring, Maryland, United States

Presenting Author(s)

Christina R. Greene, PhD
– DHHS/FDA, Silver Spring, Maryland, United States

Co-Author(s)

Rose Radin, PhD
– Team Lead, Food and Drug Administration, Silver Spring, MD, United States
Saranrat Wittayanukorn, PhD
– Epidemiologist, U.S. Food and Drug Administration, Silver Spring, MD, United States
Jennifer G. Naples, PharmD, BCPS, BCGP
– Safety Evaluator, Food and Drug Administration, United States
Candice L. Collins, DrPH
– Epidemiologist, Food and Drug Administration, United States
Judy Staffa, PhD
– Associate Director of Public Health Initiatives, Food and Drug Administration, United States

Background: Recent studies noted increases in opioid-related emergency department (ED) visits and hospitalizations in older adults but did not explore the intent of opioid use in the resulting ED visits.

Objectives: Examine national estimates of ED visits for prescription opioid-related adverse events (AEs), overall and by intent for use, and the underlying adverse effects leading to the ED encounter in U.S. adults, ages 55 and older, from 2016 to 2018.

Methods: Nationally-representative data on ED visits related to AEs from prescription opioid use in older adults came from the National Electronic Injury Surveillance System—Cooperative Adverse Drug Event Surveillance (NEISS-CADES) project, a stratified probability sample of hospitals with at least six beds and a 24-hour ED. Trained coders reviewed clinical records of ED visits to identify clinician-diagnosed medication-related AEs. We calculated average annual national estimates and population-adjusted rates, with 95% confidence intervals (CI), of prescription opioid-related visits, overall and by documented intent—nonmedical use (misuse, abuse, or overdose without indication of intent), therapeutic use, or self-harm—and documented adverse effects, stratified by age group (55-64, 65-74, 75+ years).

Results: From 2016-2018, there were an estimated 246,813 ED visits for prescription opioid-related AEs by older adults. For adults ages 55-64, the annual population-adjusted rate of these visits nominally decreased from 110.7 [95% CI: 78.3-143.2]) to 81.9 [95% CI: 53.7-110.1] per 100,000 individuals from 2016 to 2018. For adults 65+, the rate nominally decreased from 94.8 [95% CI: 57.3-132.3] to 66.9 [95% CI: 49.1-84.8] per 100,000 individuals. Over this entire three-year period, intent of opioid use in these ED visits differed by age group (55-64, 65-74, and 75+): therapeutic use (43.9% [95% CI: 37.0-50.8%], 65.4% [95% CI: 59.7-71.1%], and 86.5% [95% CI: 82.8-90.3%]); nonmedical use (46.6% [95% CI:38.3-55.0%], 26.4% [95% CI:19.2-33.6%], and 8.1% [95% CI: 3.8-12.3%]); and self-harm (9.5% [95% CI: 6.4-12.6%], 8.2% [95% CI: 3.9-12.6%], and 5.4% [95% CI: 3.4-7.4%]), respectively. Frequently observed AEs were altered mental status, cardiorespiratory effects, and gastrointestinal effects.

Conclusions: The rate of prescription opioid-related ED visits from 2016 to 2018 among U.S. older adults did not increase, in contrast to studies that found previous increases in opioid-related ED visits and hospitalizations. The percent of these visits due to therapeutic use increased with older age, and visits due to this reason were more prevalent than visits due to nonmedical use in adults 65-74 and 75+.