Patterns of Prescription Opiate Use by Aged, Blind or Disabled Clients in Washington State

In a previous study we found that many aged, blind, or disabled clients who are frequent visitors to the hospital emergency room (ER) receive large volumes of prescription narcotic analgesics (opiates). This study sheds light on patterns of prescription opiate use by these clients, including the conditions associated with heavy opiate use, receiving opiate prescriptions from multiple providers, and making frequent ER visits. We find: A significant number of aged, blind, or disabled clients receive large volumes of opiates from multiple prescribing providers. In Fiscal Year 2002, at least 2,155 aged, blind, or disabled clients received a total of 366 or more days of opiates prescribed by at least three different providers. It is a concern that many aged, blind, or disabled clients who receive large volumes of opiates have a clear indication of drug addiction in their medical record (diagnoses of drug abuse, dependence, or drug-induced psychosis). Clients with headaches, poisonings, tobacco abuse, sprains, strains, and superficial injuries receive large volumes of opiates and are frequent ER visitors. These conditions may signal increased risk of opiate addiction. By comparison, clients who have cancer, HIV/AIDS, arthritis, and diseases of the spine also receive large volumes of opiates, but are less frequent ER visitors. Although some of these clients have indications of drug addiction, opiate use patterns among these clients appear to be more appropriate. The underlying cause of heavy opiate use and frequent ER visits in many cases may be opiate addiction. In other cases, the cause may be inadequate pain management or lack of access to primary medical care. Clinical review is necessary to determine the cause of potentially problematic prescription opiate use and frequent ER visits for specific clients. What is clear is the potential for better care management for many of these clients.