High Variability of Opioid Prescribing Within and Across Emergency Departments in the US Veterans Health Administration

Persons experiencing pain who seek treatment in emergency departments (EDs) frequently receive opioid prescriptions. These prescriptions may lead to chronic, inappropriate use of opioids and opioid-related harm.1–3 The Veterans Health Administration (VA) has implemented a nation-wide intervention promoting safe opioid prescribing, including clinician education, guidelines for prescribing opioids for chronic pain, assessing and mitigating opiate risk, and tracking clinician opiate safety practices.4 This likely contributed to fewer opioid prescriptions provided upon discharge from VA EDs, decreasing annually since 2011.5 Despite this overall decline, little is known about the variability of prescribing practices among individual VA ED clinicians. The VA is a unique environment for describing clinician, facility, and regional variation in prescribing practices, given the uniform insurance benefit and national scope of care. Data on opioid prescribing variability may help guide the development of interventions to reduce unsafe opioid prescribing in VA EDs. We sought to describe clinician-, facility-, and regional-level opioid prescribing practices in VA EDs.