Analysis of opioid prescribing: emergency departments in the U.S. military system 2006-10
Background: The recent increase in opioid-related deaths may be related to increased provider
prescribing and opioid misuse. Within the Military Health System, there is a persistent concern
regarding opioid-related adverse outcomes has been reported in the military although there are
no published reports on opioid prescribing trends among military healthcare facilities, especially
the emergency departments (ED). The military’s closed healthcare network is an optimal system
to evaluate opioid prescribing patterns. Objective: To describe the opioid prescribing patterns in
military EDs from 2006-2010. Methods: In collaboration with the Air Force’s Health
Informatics Division, prescription data was extracted from the DoD Pharmacy Transaction Data
Service. Any Tricare beneficiary >18 years of age who received an opioid prescription in a
military ED from 2006 to 2010 was included. We evaluated differential trends in the number of
prescriptions per patient and in the duration of opioid prescriptions per patient (prescriptiondays). Using SAS 9.2 (Cary, NC), chi square test-of-trends was performed with alpha = 0.05.
Results: In the baseline year (2006), 1,284,388 opioid prescriptions were written in primary
care, ED, surgical, and dental clinics; 149,322 were written in the ED. Over the study period
(2006 – 2010), we found a decrease in the duration of oxycodone and hydrocodone prescriptions
per patient from 2006 – 2010 as well as a decrease on opioid prescription duration among males
and females. Additionally, the duration of prescriptions decreased among all ages groups while
an increase in the number of prescriptions/ patient was observed only among those 25-34 years
of age. Furthermore, duration of prescriptions decreased among active duty/guard, their
dependents, retirees, and dependents/survivors of retirees. Conclusion: From 2006 – 2010,
opioid prescriptions originating in military emergency departments decreased overall and among
several subgroups suggesting the need to identify underlying factors that effected these trends.
Maj Joshua B. Pead, USAF, MC, FS1
Lt Col Vikhyat S. Bebarta, USAF, MC1
Rosemarie Ramos, PhD, MPH3
Jennifer S. Potter, PhD, MPH2
Lee A. Zarzabal, MS3
Celan Alo, MD, MPH4
Lt Col David Carnahan, MD, MSCE, USAF4
Maria Castaneda, MS5
1
Dept of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX
2
University of Texas Health Sciences Center-San Antonio, TX
3
59th MDW AF Science and Technology Office
4
AFMSA Healthcare Informatics Division
5
CREST Program, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX
Correspondence:
Maj Joshua Pead
Email: jkpead@me.com
Phone: 210-563-3787