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Rates and Predictors of Using Opioids in the Emergency Department to Treat Migraine in Adolescents and Young Adults

Connelly, Mark PhD; Glynn, Earl F. MS; Hoffman, Mark A. PhD; Bickel, Jennifer MD

doi: 10.1097/PEC.0000000000001851
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Objectives This study aimed to determine the rate and context in which opioids are used to treat migraine in adolescents and young adults seen in emergency care settings.

Methods Data from 2010 to 2016 in the Cerner Health Facts electronic health record data warehouse were analyzed using multilevel logistic regression to estimate the population likelihood of an opioid being used in the emergency department (ED) to treat a primary diagnosis of migraine in adolescents and young adults and to evaluate the extent to which this likelihood varies as a function of characteristics of the patient (age, sex, race, and insurance), encounter (referral source, provider specialty, and encounter duration and year), and ED (region, setting, size, payer mix, and academic status).

Results The study identified 14,494 eligible ED encounters with unique patients, of which 23% involved an opioid. Likelihood of being treated with opioids was significantly higher for patients who were older, female, white, and seen by a surgeon and who had longer encounters and encounters earlier in the time period sampled. Sites varied widely in percentage of encounters involving opioids (men, 26.4% ± 20.1%; range, 0–100%), with higher rates associated with smaller sites with relatively higher proportions of commercially insured patients.

Conclusions Use of opioids in the ED to treat migraine in youth is fairly common, with rate variation reflecting broader trends in for whom opioids tend to be more likely to be prescribed. These findings may be helpful for benchmarking and informing quality improvement efforts aimed at reducing unwarranted opioid exposure in youth.

From the Children's Mercy Kansas City, Kansas City, MO.

This work was funded through internal initiatives at the University of Missouri–Kansas City and Children's Mercy Hospital.

Disclosure: The authors declare no conflict of interest.

Reprints: Mark Connelly, PhD, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO 64108 (e-mail: mconnelly1@cmh.edu).

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