For patients taking chronic opioids with or without an overlapping benzodiazepine prescription, the rate of emergency department (ED) visits and hospitalizations decreased in the United States from 2009 to 2015, according to a study published in The Clinical Journal of Pain.

Researchers conducted a retrospective cohort analysis using the MarketScan database to identify patients aged ≥18 years who were prescribed opioids for at least 90 days between 2009 and 2015 (N= 2,533,878). Patients were excluded if they had cancer or were receiving palliative or hospice care. The number of patients with chronic opioid use, opioid-related ED visits, and opioid-related hospitalizations was calculated for both year and region.

Approximately 60% of the study population were women; median age remained consistent throughout the study period (54 in 2009 and 55 in 2015). The North Central region had the largest percentage of individuals taking opioids chronically (2.7%, n=129,915) in 2015, with the Northeast at the lowest percentage (1.5%, n=66,443).  For the duration of the study, the rate of opioid-related ED visits decreased from 85 per 100,000 people in 2009 to 73 per 100,000 in 2015. The South was the region with the highest rate of opioid-related ED visits in 2015 (23 per 100,000), while the Northeast again had the lowest (15 per 100,000). No significant difference was found for overall ED visit rates by year.

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Opioid-related hospitalizations decreased from 168 per 100,000 in 2009 to 103 per 100,000 in 2015. The South had the highest rate of hospitalizations for all years, with 39 per 100,000 reported in 2015. The West had the lowest rate in 2015 at 19 per 100,000.

Approximately 66% of patients with an opioid-related ED visit and 73% of patients with an opioid-related hospitalization had an overlapping benzodiazepine prescription. The rate of opioid-related ED visits for patients also receiving a benzodiazepine decreased from 2009 to 2015 (160 per 100,000 people to 137 per 100,000). The West had the highest rate for all years at 42 per 100,000 in 2015, and the Northeast had the lowest with 27 per 100,000. The hospitalization rate decreased from 327 per 100,000 in 2009 to 203 per 100,000 in 2015. The Northeast once again had the lowest rate for all years, with 33 per 100,000 in 2015, while the South had the highest with 67 per 100,000.

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Although the rates for opioid-related ED visits and hospitalizations decreased, the authors caution that “more research is needed to examine regional variation in chronic pain management and if or how concurrent opioid and benzodiazepine use can be less dangerous.”


Kay C, Bernstein J, Fergestrom N, Jackson JL. Opioid-related emergency department visits and hospitalizations among commercially Insured Individuals, 2009-2015 [published online August 14, 2018]. Clin J Pain. doi: 10.1097/AJP.0000000000000643