Emerg Med J 29:201-204 doi:10.1136/emj.2010.097949
  • Original article

Disparities in opioid prescribing for patients with psychiatric diagnoses presenting with pain to the emergency department

  1. Mark J Pletcher4
  1. 1Center for Mental Health Services Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Temple University School of Medicine, Philadelphia, Pennsylvania, USA
  3. 3The University of Miami School of Law, Miami, USA
  4. 4Department of Epidemiology and Biostatistics, and Medicine, University of California, San Francisco, California, USA
  1. Correspondence to Lorna J Simon, Center for Mental Health Services Research, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655, USA; lorna.simon{at}
  • Accepted 24 January 2011
  • Published Online First 18 February 2011


Background The goal of this investigation is to discover whether or not patients with psychiatric diagnoses are less likely to be prescribed opioids for pain in emergency departments compared with other patients.

Methods Pain-related visits to US emergency departments were identified using reason-for-visit and physician diagnosis codes for 13 years (1993–2005) of the National Hospital Ambulatory Medical Care Survey. The outcome measure was the prescription or administration of an opioid analgesic.

Results Roughly 10 million pain-related visits were made by persons with psychiatric diagnoses in the USA between 1993 and 2005. Across all years, only 18% (95% CI 16 to 20) of pain-related visits by patients with psychiatric diagnoses resulted in an opioid prescription, whereas 33% (95% CI 32 to 34) of visits by other patients did. Lower prescription rates for patients with psychiatric diagnoses were seen for every year of the survey and this difference occurred at every level of pain severity. Controlling for confounding factors did not attenuate this difference. In a multivariate model, patients with psychiatric diagnoses were about half as likely as other patients to be prescribed opiates (adjusted OR 0.49; 95% CI 0.44 to 0.56). Major limitations of the study include the uncertain precision of psychiatric and drug/alcohol diagnoses and the lack of detail about each patient visit.

Conclusion Having a psychiatric diagnosis was associated with a lower likelihood of receiving an opioid among persons presenting with pain to the ED.


  • Funding This research was funded in part by a grant from the Agency for Healthcare Research and Quality (R03HS016238).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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