Objectives: Pain is the most common reason patients present to the emergency department (ED), comprising almost 80% of visits. Opioid analgesics are associated with substantial side effect burden and abuse potential. Emergency medicine (EM) physicians are increasingly aware of the risks of opioids, and increasing evidence and guidelines on alternative pain management regimens. In this study, we reviewed the trends of opioid and other non-opioid medication administration in hospitals across the nation throughout the past decade.
Design: A retrospective review was done for patients who received opioid and non-opioid medications during their ED encounter. The Epic Cosmos data set was queried for de-identified patient visits to EDs where opioids or NSAIDs were administered, between January 1 2014 and December 31, 2022. NSAID medications for this study were limited to toradol and ibuprofen.
Results: As percentages of total ED (or pediatric ED) visits, opioid administrations were twice as common as ketorolac in 2014. Since that time, ketorolac usage consistently climbed and opioid use consistently decreased, resulting in slightly higher rates of ketorolac orders by the year 2022. Other medications such as ibuprofen have not significantly changed in use in 2022 when compared to 2014.
Conclusions: In the Epic Cosmos data set, the fraction of visits with opioid administration in the ED have declined, while ketorolac use has increased, from 2014 to 2022. The decline in opioid orders in the ED is likely the result of greater awareness of the risks related to opioid use disorder. The rise in ketorolac orders, however, is more difficult to explain - particularly when compared to the more stagnant levels of ibuprofen ordering. Ketorolac is commonly given via intramuscular or intravenous routes; research suggests oral ibuprofen is comparable to IM ketorolac. Patients do not seem to prefer medications delivered via injection to oral routes though perhaps clinicians believe they do.
