Prevalence of Prescription Medication Misuse in Patients Presenting to the Emergency Department

In the early 1990s multiple studies displayed the inadequate treatment of acute pain for patients presenting to Emergency Departments across the U.S. As a result, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) modified the standard of care in regards to acute pain management, which required more consistent assessments and diligent treatments. Subsequently, the average number of prescribed opioid analgesics in the U.S. increased from 96 mg of morphine equivalents per person in 1997 to approximately 700 mg per person in 2007. Furthermore, the number of unintentional opioid drug overdose deaths increased from 3,000 to 12,000 per year. Clinicians and policy makers are now working to reduce the effects of this new prescription drug epidemic. Data for this study was collected from patients presenting to the ED of Parkland Memorial Hospital (PMH) with a chief complaint of 'back pain' or 'back injury' via a confidential, self-reporting survey designed to obtain demographic information, a brief medical history, and pain and anxiety medication use habits. Statistical analysis of 132 patients revealed that 71 (53.8%) patients have used prescription pain or anxiety drugs in the past 3 months, with 30 (22.7%) utilizing them on a daily or near daily basis. Although only 6 (4.6%) patients admitted to struggling with pain or anxiety medication misuse and 0 (0%) admitted to utilizing current prescription medications for recreational purposes, 12 (9.1%) reported personal troubles, 12 (9.1%) reported a failure to do what was normally expected of them at some point in the past 3 months, and 9 (6.8%) reported a friend or relative expressing concern about substance use. 24 patients reported having a current prescription for pain or anxiety medication. Of these, 17 (70.8%) were obtained from either ED or primary care physicians. A number of relationships were also analyzed in order to determine at-risk individuals. Education level showed a statistically significant association with pain or anxiety medication use in the past 3 months (p=0.003), while a history of chemical dependence therapy was correlated with the expression of concern from friends or family in regard to substance use (p=0.02). This data may be used to determine the prevalence and cause of prescription drug misuse among patients presenting to EDs, providing clinicians with promising areas of intervention. Understanding the scope of the issue, coupled with the ability to prevent habitual drug misuse prior to its initiation, may serve to alleviate some of the negative effects associated with this new epidemic.