Use of Controlled Medications in the Emergency Department: Narcotics and Psychotropics

Objective: Although the trends and outcomes of controlled medications prescribed by emergency physicians especially opioids are well-defined in the literature, there is insufficient evidence regarding their parenteral use during emergency department (ED) visits. Thus, we aimed to determine the prevalence use of these drugs and the conditions under which they are ordered. Methods: We conducted a retrospective study from January to June 2018 at a secondary care ED in Turkey. Narcotics and psychotropics, were administered parenterally (intravenous or intramuscular) during patients' ED visits. We obtained the following data from the registry and hospital records: time of use, age, sex, diagnosis, drug (active ingredient), and type of physician (general practitioner or attending). Results: During the six-month study period, parenteral controlled medication was used in 1111 ED visits (1% of all ED visits). Tramadol and pethidine were the most commonly used narcotic drugs in the ED. They were often used for musculoskeletal pain (29.1% and 47.1%, respectively) and abdominal pain (22.5% and 18.6%, respectively). ED revisits of patients who took these drugs were related to cancer pain. Meanwhile, diazepam and biperiden were the predominantly used psychotropics. Anxiety/agitation was diagnosed in 69.1% of patients who received diazepam and acute exacerbation of psychiatric diseases in 70.6% of patients who received biperiden. However, revisits of these patients to the ED were related to acute exacerbation of psychiatric diseases. Conclusion: The rate of controlled medication use in the studied hospital is much lower than that in developed countries. This finding can be attributed to different factors, such as physician attitude, patient demands, and possibly cultural differences. Finally, revisits of these patients to the ED were mostly related to acute exacerbation of chronic diseases.