Schwartz/Reisman Emergency Medicine Institute

Opiate Prescribing

Opiate Prescribing in Ontario Emergency Departments

Demand for opiate medications, especially high potency formulations, has skyrocketed in the last two decades. Largely prescribed for chronic non-cancer pain, this well-intentioned increase in high potency opiate use has been associated with significant harm. One in 8 deaths in 25-34 year olds in Ontario is the result of prescription opiate overdose, and death from prescription opioid overdose, the vast majority of which are accidental, exceeds death from all traditional drugs of abuse combined. Much of the harm from opioid prescribing occurs in individuals with no record of a prescription, confirming that many prescribed opiates are being sold on the black market.

Little is known regarding opiate prescribing in the emergency department (ED). SREMI researchers have partnered with Dr. Tara Gomes and the Ontario Drug Policy Research Network to complete a large, population-based observational study using administrative data to clarify the role and contribution of emergency physicians (compared to other prescribers) in the initiation of opioids among patients in Ontario. We will also investigate the downstream impact of this initiation, including well-established indicators of potentially unsafe opioid use such as high dose use and hospitalization for drug toxicity.

We believe that documentation of prescribing practice by emergency physicians and exploring the potential consequences of this practice will inform a rational approach to the prescribing of opiate medications in the acute care setting.