Journal of General Internal Medicine

, Volume 33, Issue 11, pp 1831–1832 | Cite as

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

  • Timothy Joseph SowiczEmail author
  • Adam J. Gordon
  • Walid F. Gellad
  • Xinhua Zhao
  • Hongwei Zhang
  • Thomas Emmendorfer
  • Chester B. Good
Concise Research Reports


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, 2, 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 2011.5Despite 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...


opioid Veterans emergency department prescribing 



This work was conducted with resources from the Veterans Health Administration’s Pharmacy Benefits Management Services, Washington, D.C., USA; the Center for Health Equity and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; and the Informatics, Decision Enhancement and Analytic Sciences Center (IDEAS2), VA Salt Lake City Health Care System, Salt Lake City, UT, USA. The supporting organizations had no role in the preparation, review, or approval of the manuscript or decision to submit the manuscript for publication.

Compliance with ethical standards

Prior presentations


Conflict of interest

The authors declare that they do not have a conflict of interest.


The contents of this work do not represent the views of the United States Department of Veterans Affairs or the United States Government. The Veterans Health Administration’s Pharmacy Benefits Management Services approved and designated this work as a quality improvement project.


  1. 1.
    Poon SJ, Greenwood-Ericksen MB. The opioid prescription epidemic and the role of emergency medicine. Ann Emerg Med. 2014;64:490–95.CrossRefGoogle Scholar
  2. 2.
    Lynch MJ, Yealy DM. Looking ahead: the role of emergency physicians in the opioid epidemic. Ann Emerg Med. 2018.Google Scholar
  3. 3.
    Barnett ML, Olenski AR, Jena AB. Opioid-prescribing patterns of emergency physicians and risk of long-term use. N Engl J Med. 2017;376:663–73.CrossRefGoogle Scholar
  4. 4.
    Gellad WF, Good CB, Shulkin DJ. Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs. JAMA Intern Med 2017;177(5):611–12.CrossRefGoogle Scholar
  5. 5.
    Grasso MA, Dezman ZDW, Grasso CT, Jerrad DA. Opioid pain medication prescriptions obtained through emergency medical visit in the Veterans Health Administration. J Opioid Manag. 2017;13:77–84.CrossRefGoogle Scholar
  6. 6.
    Department of Veterans Affairs. 2012 VHA facility quality and safety report. Available at: Accessed 24 Apr 2018.

Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2018

Authors and Affiliations

  • Timothy Joseph Sowicz
    • 1
    Email author
  • Adam J. Gordon
    • 2
  • Walid F. Gellad
    • 3
  • Xinhua Zhao
    • 4
  • Hongwei Zhang
    • 3
  • Thomas Emmendorfer
    • 4
  • Chester B. Good
    • 4
  1. 1.VA Pittsburgh Healthcare System, VA Pittsburgh’s Interdisciplinary Addiction Program for Education and Research (VIPER)PittsburghUSA
  2. 2.VA Salt Lake City Health Care SystemSalt Lake CityUSA
  3. 3.Center for Health Equity and Promotion (CHERP)VA Pittsburgh Healthcare SystemPittsburghUSA
  4. 4.Veterans Health Administration, Pharmacy Benefits Management Services (PBM)WashingtonUSA

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