NCHS Data Brief ■ No. 338 ■ May 2019

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.

Opioids Prescribed at Discharge or Given During Emergency

Department Visits Among Adults in the United States, 2016

Pinyao Rui, M.P.H., and Susan M. Schappert, M.A.

Key findings

National Hospital 

Ambulatory Medical Care 

Survey

● In 2016, opioids were 

given during the visit and a 

prescription for opioids was 

provided at discharge at 35.4 

emergency department (ED) 

visits per 1,000 adults. Opioids 

were only given during the ED 

visit at 53.4 visits per 1,000 

adults, whereas opioids were 

only prescribed at discharge at 

38.4 visits per 1,000 adults.

● Among ED visits where 

opioids were given at the visit, 

prescribed at discharge, or both, 

opioids were most likely to be 

only given during the visit for 

visits paid by private insurance, 

Medicare, or Medicaid.

● Among ED visits where 

opioids were given at the visit, 

prescribed at discharge, or both, 

opioids were most likely to be 

only prescribed at discharge 

for visits primarily for injury 

or trauma.

Opioid analgesics are primarily used to treat chronic and acute pain and, when 

used appropriately, can be an important part of treatment (1). Pain is a major 

symptom of patients visiting the emergency department (ED), with up to 42% 

of ED visits being related to pain (2). Opioids may either be administered 

in the ED as part of treatment, provided post-treatment in the form of a 

prescription, or both (3). This report compares rates and percentages of ED 

visits by adults at which opioids were only given in the ED, only prescribed at 

discharge, or both, by selected characteristics.

The rate of ED visits with opioids only given in the ED was 

higher than the rate for visits with opioids only prescribed at 

discharge and visits with both given and prescribed opioids.

● In 2016, opioids were given during the visit and a prescription for 

opioids was provided at discharge at 35.4 emergency department (ED) 

0

25

50

75

53.4

38.4 35.4

61.5

42.6 39.4

44.7

34.0 31.0

Overall Women Men

Only given in ED Only prescribed at discharge Both given and prescribed 1

Figure 1. Rate of emergency department visits with opioids given in emergency departments, 

prescribed at discharge, or both, per 1,000 adult women and men: United States, 2016

1

Estimate for women is significantly different than estimate for men.

NOTES: Estimate for only given in ED is significantly different than estimates for only prescribed at discharge and both given and 

prescribed. ED is emergency department. Visits with opioids given in ED, prescribed at discharge, or both are defined using the 

Cerner Multum's Lexicon third level therapeutic category codes 60 (narcotic analgesics) and 191 (narcotic analgesic 

combinations). Data for 0.2% of visits with missing given or prescribed status are not shown. Visit rates are based on the July 1, 

2016, set of estimates of the civilian noninstitutionalized population developed by the U.S. Census Bureau’s Population Division. 

Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db338_tables-508.pdf#1.

SOURCE: National Hospital Ambulatory Medical Care Survey, 2016. Visit rate per 1,000 adults
NCHS Data Brief ■ No. 338 ■ May 2019

■  2  ■

visits per 1,000 adults, which was similar to the rate of visits with opioids only prescribed 

at discharge (38.4). The rate of ED visits where opioids were only given during the visit 

(53.4) was higher compared with visits where opioids were given and prescribed, and only 

prescribed (Figure 1).

● Among women, opioids were only given at the ED visit at 61.5 visits per 1,000, which was 

higher than the rate for visits with opioids only prescribed at discharge (42.6) and visits 

where opioids were both given at the visit and prescribed at discharge (39.4).

● Among men, opioids were only given at the ED visit at 44.7 visits per 1,000, which was 

higher than the rate for visits with opioids only prescribed at discharge (34.0) and visits 

where opioids were both given and prescribed at discharge (31.0). 

● The ED visit rate where opioids were only given at the ED visit was higher for women 

compared with men. 

Among adults aged 45 and older, the rate of ED visits with opioids only 

given was higher than the rate for visits with opioids only prescribed or 

both given and prescribed.

● Among adults aged 18–44, opioids were only given at the ED visit at 46.3 visits per 1,000, 

which was similar to the rate for visits with opioids only prescribed at discharge (45.8) and 

higher than the rate for visits with opioids both given and prescribed at discharge (35.8). The 

Figure 2. Rate of emergency department visits with opioids given in emergency departments, prescribed at discharge, or 

both, per 1,000 adults aged 18–44, 45–64, and 65 and over: United States, 2016

1

Estimate for adults aged 18–44 is significantly different than estimate for adults aged 45–64.

2

Estimate for adults aged 18–44 is significantly different than estimate for adults aged 45–64 and 65 and over.

3

Estimate for only given in ED is significantly different than estimates for both given and prescribed.

4

Estimate for only given in ED is significantly different than estimates for only prescribed at discharge and both given and prescribed.

NOTES: ED is emergency department. Visits with opioids given in ED, prescribed at discharge, or both are defined using the Cerner Multum's Lexicon third level 

therapeutic category codes 60 (narcotic analgesics) and 191 (narcotic analgesic combinations). Data for 0.2% of visits with missing given or prescribed status are 

not shown. Visit rates are based on the July 1, 2016, set of estimates of the civilian noninstitutionalized population developed by the U.S. Census Bureau’s 

Population Division. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db338_tables-508.pdf#2.

SOURCE: National Hospital Ambulatory Medical Care Survey, 2016. Visit rate per 1,000 adults

46.3 45.8

35.8

59.4

33.4

39.2

59.6

29.9

27.6

0

25

50

75 Only prescribed at discharge Both given and prescribed Only given in ED1 2

65 and over4 45–644 18–443
NCHS Data Brief ■ No. 338 ■ May 2019

■  3  ■

observed difference between the rates where opioids were only prescribed at discharge and 

both given and prescribed was not significant (Figure 2).

● Among adults aged 45–64, the ED visit rate was higher where opioids were only given 

at the ED visit (59.4) compared with the rate for visits with opioids only prescribed at 

discharge (33.4) and both given and prescribed at discharge (39.2).

● Among adults aged 65 and over, the ED visit rate was higher where opioids were only 

given at the ED visit (59.6) compared with the rate for visits with opioids only prescribed at 

discharge (29.9) and both given and prescribed at discharge (27.6).

● The ED visit rate for visits with opioids only prescribed at discharge was higher for adults 

aged 18–44 (45.8) compared with older adults aged 45–64 (33.4) and 65 and over (29.9).

● The ED visit rate where opioids were only given at the ED visit was higher for older 

adults aged 45–64 (59.4) compared with younger adults aged 18–44 (46.3). The observed 

difference between the visit rates for adults aged 18–44 and 65 and over was not significant.

Opioids were only given at around one-half of ED visits where opioids were 

given, prescribed, or both and where Medicare was the primary expected 

source of payment.

Figure 3. Percentage of emergency department visits by adults with opioids given in emergency departments, prescribed 

at discharge, or both, by primary expected source of payment: United States, 2016

1

Estimates for only given in ED is significantly different than estimates for only prescribed at discharge and both given and prescribed.

NOTES: ED is emergency department. Visits with opioids given in ED, prescribed at discharge, or both are defined using the Cerner Multum's Lexicon third level 

therapeutic category codes 60 (narcotic analgesics) and 191 (narcotic analgesic combinations). Data for 0.2% of visits with missing given or prescribed status are 

not shown. No charge are visits for which no fee is charged (e.g., charity, special research, or teaching). Access data table for Figure 3 at: 

https://www.cdc.gov/nchs/data/databriefs/db338_tables-508.pdf#3.

SOURCE: National Hospital Ambulatory Medical Care Survey, 2016. Percent

41.9

30.2

27.7

39.9

50.6

24.8 24.1

41.4

31.4

27.1

30.8 29.1 29.8

33.6

36.5

Only given in ED Only prescribed at discharge Both given and prescribed

Medicaid Self-pay or no charge Overall1 Private1 Medicare1 1

0

25

50

75
NCHS Data Brief ■ No. 338 ■ May 2019

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● Among ED visits where opioids were given at the visit, prescribed at discharge, or both, 

41.9% were only given at the ED visit, which was higher than both the percentage of visits 

with opioids only prescribed at discharge (30.2%) and visits with opioids both given and 

prescribed (27.7%) (Figure 3). 

● Among ED visits where opioids were given at the visit, prescribed at discharge, or both, 

the percentage of visits where opioids were only given at the ED visit was higher than the 

percentage of visits where opioids were only prescribed at discharge, or both given and 

prescribed, when the primary expected source of payment for the visit was private insurance 

(39.9%), Medicare (50.6%), or Medicaid (41.4%). 

The type of opioid administration among ED visits where opioids were 

given, prescribed, or both varied according to primary diagnosis.

● Among ED visits where opioids were given at the visit, prescribed at discharge, or both, 

with a primary diagnosis of injury or trauma, the percentage with opioids only prescribed 

at discharge (40.7%) was higher than both the percentage of visits with opioids only given 

at the visit (26.3%) and visits with opioids both given and prescribed at discharge (32.7%) 

(Figure 4).

● For ED visits with a primary diagnosis of abdominal pain, where opioids were given at the 

visit, prescribed at discharge, or both, 50.3% included opioids only given at the visit, which 

Figure 4. Percentage of emergency department visits by adults with opioids given in emergency departments, prescribed 

at discharge, or both, by selected primary diagnoses: United States, 2016

1

Estimate for only prescribed at discharge is significantly different than estimates for only given in ED and both given and prescribed.

2

Estimates for only given in ED, only prescribed at discharge, and both given and prescribed are significantly different from each other.

3

Estimate for only given in ED is significantly different than estimates for only prescribed at discharge and both given and prescribed.

NOTES: ED is emergency department. Visits with opioids given in ED, prescribed at discharge, or both are defined using the Cerner Multum's Lexicon third level 

therapeutic category codes 60 (narcotic analgesics) and 191 (narcotic analgesic combinations). Data for 0.2% of visits with missing given or prescribed status are 

not shown. Diagnoses are coded according to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD–10–CM). Access data table for 

Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db338_tables-508.pdf#4.

SOURCE: National Hospital Ambulatory Medical Care Survey, 2016. Percent

26.3

40.7

32.7

50.3

35.5

31.4 33.1 32.1 33.8 34.1

19.4

29.8

20.0

62.2

17.9

Only given in ED Only prescribed at discharge Both given and prescribed

0

25

50

75

Chest pain Abdominal pain2 Back pain Extremity pain 3 Injury or trauma1
NCHS Data Brief ■ No. 338 ■ May 2019

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was higher than both the percentage of visits with opioids only prescribed at discharge 

(19.4%) and visits with opioids both given and prescribed (29.8%); additionally, the 

percentage of visits with opioids only prescribed at discharge was lower than that of visits 

with opioids both given and prescribed. 

● For ED visits with a primary diagnosis of chest pain, where opioids were given at the visit, 

prescribed at discharge, or both, 62.2% included opioids only given at the visit, which was 

higher than both the percentage of visits with opioids only prescribed at discharge (17.9%) 

and visits with opioids both given and prescribed (20.0%). 

Summary

In 2016, there were an estimated 53.4 ED visits per 1,000 adults with opioids given in the ED, 

38.4 visits per 1,000 adults with opioids prescribed at ED discharge, and 35.4 visits per 1,000 

adults that included opioids both given at the ED visit and prescribed at discharge. The rate of 

visits where opioids were only given at the ED visit, compared with visits where opioids were 

only prescribed at discharge, or were both given and prescribed, was higher among patients aged 

45 and over and for both women and men. The rate where opioids were only given at the ED visit 

was higher for women than men and adults aged 45–64 than for adults aged 18–44 years. The rate 

of visits with opioids only prescribed at discharge was higher for younger adults compared with 

older adults.

Opioids were only given at the ED visit at a significantly higher percentage of visits where 

opioids were given, prescribed, or both, where the primary expected source of payment was 

Medicare (50.6%) compared with opioids only prescribed at discharge (24.8%); this pattern likely 

reflects the age distribution differences showing higher rates of opioids given in the ED among 

visits made by older patients. Opioids were only prescribed at discharge at a higher percentage of 

visits where opioids were given, prescribed, or both, with a primary diagnosis of injury or trauma, 

compared with opioids given in the ED. The reverse pattern was observed among visits where 

opioids were given, prescribed, or both, with primary diagnoses of chest pain and abdominal 

pain in which the percentage of visits with opioids only given at the ED visit was higher than the 

percentage of visits with opioids only prescribed at discharge.

Definitions

Emergency department visits with opioids given in ED, prescribed at discharge, or both given 

and prescribed: Opioids were defined using the Cerner Multum’s Lexicon third level therapeutic 

category codes for narcotic analgesics (60) and narcotic analgesic combinations (191). Data 

for up to 30 drugs and corresponding given or prescribed statuses could be collected per visit 

record. In 2016, 25.0% of adult ED visits with at least one opioid mention (i.e., opioid was given, 

prescribed, or both) included more than one opioid mention in the medical record. Given in ED, 

prescribed at discharge, or both given and prescribed are mutually exclusive and derived from the 

drug variables GPMED1–GPMED30, which have the following values: given in ED; prescribed 

at discharge; both given in ED and prescribed at discharge; not applicable; and blank. In 2016, 

27.7% (Figure 3) of adult ED visits with at least one opioid mention contained opioid(s) that were 

both given and prescribed.
NCHS Data Brief ■ No. 338 ■ May 2019

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Only given in ED: Visits with opioids that were only given in the ED. This could include visits 

for which extra opioids were given to the patient to take home without a prescription; however, 

the extent to which this happens cannot be measured from the data. If visit included more than 

one opioid mention, all opioids must have the designation of “given in ED.”

Only prescribed at discharge: Visits with opioids that were only prescribed at discharge from 

the ED. If visit included more than one opioid mention, all opioids must have the designation of 

“prescribed at discharge.”

Both given and prescribed: Visits with opioids that were both given in ED and prescribed at 

discharge from the ED. If visit included one opioid mention, the opioid must have the designation 

of “both given in ED and prescribed at discharge;” if visit included more than one opioid 

mention, the combination of all opioid mentions in the visit must include a designation of “given 

in ED,” “prescribed at discharge,” or “both given in ED and prescribed at discharge.”

Primary expected sources of payment: During data collection, all sources of payment were 

collected. These sources of payment were collapsed into one mutually exclusive variable (primary 

expected source of payment) that ranks payment sources based on the hierarchy below:

Medicare: Partial or full payment by Medicare plan includes payments made directly to the 

hospital as well as payments reimbursed to the patient. Charges covered under a Medicaresponsored prepaid plan are included.

Medicaid: Partial or full payment by Medicaid plan includes payments made directly to the 

hospital or reimbursed to the patient. Charges covered under a Medicaid-sponsored prepaid 

plan (HMO) or “managed Medicaid” are included. 

Private: Partial or full payment by a private insurer (e.g., BlueCross BlueShield), either 

directly to the hospital or reimbursed to the patient. Charges covered under a private insurance 

sponsored prepaid plan are included.

Self-pay or no charge: Includes self-pay, no charge, or charity. Self-pay are charges that are 

paid by the patient or patient’s family, which will not be reimbursed by a third party. Self-pay 

includes visits for which the patient is expected to be ultimately responsible for most of the 

bill, even if the patient never actually pays it. This does not include copayments or deductibles. 

No charge or charity are visits for which no fee is charged (e.g., charity, special research, or 

teaching).

Primary diagnosis: The principal diagnosis, considered to be the main cause or reason for the 

ED visit. Diagnoses are coded according to the International Classification of Diseases, 10th 

Revision, Clinical Modification (ICD–10–CM) coding system (4). The ICD–10–CM codes for the 

primary diagnoses included in Figure 4 are the following:

Injury/trauma: S00–T88, Y92–Y93

Abdominal pain: R10.0, R10.1, R10.3, R10.8

Back pain: M54

Extremity pain: M79.6, M25.51–M25.57

Chest pain: R07.1, R07.2, R07.8, R07.9
NCHS Data Brief ■ No. 338 ■ May 2019

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Data source and methods

ED visit data are from the 2016 National Hospital Ambulatory Medical Care Survey (NHAMCS), 

a nationally representative survey of nonfederal general and short-stay hospitals conducted by 

the National Center for Health Statistics. NHAMCS uses a multistage probability design with 

samples of geographic primary sampling units (PSUs), hospitals within PSUs, and patient visits 

within EDs. In 2016, 265 hospitals reported emergency department data in NHAMCS, and data 

were collected on approximately 19,000 ED visits. Additional information on the methodology of 

NHAMCS is available online (5), as is the public-use data file (6). 

The study population includes all ED visits made by patients aged 18 and over with at least one 

opioid mention in the medical record. Figures 1 and 2 display rates of ED visits, which were 

calculated by dividing the number of ED visits with opioids given in ED, prescribed at discharge, 

or both, by the July 1, 2016, estimate of the civilian noninstitutionalized population of the U.S. 

(obtained from the U.S. Census Bureau’s Population Division) for each demographic group.

Data analysis was performed using the statistical packages SAS version 9.4 (SAS Institute, Cary, 

N.C.) and SAS-callable SUDAAN version 11.0 (RTI International, Research Triangle Park,

N.C.). Differences among subgroups were evaluated using a two-tailed t test (p < 0.05). All

proportion estimates presented meet NCHS guidelines for presentation of proportions (7).

About the authors

Pinyao Rui and Susan M. Schappert are with the National Center for Health Statistics, Division of 

Health Care Statistics.
NCHS Data Brief ■ No. 338 ■ May 2019

References

1. Prescription opioid data. Centers for Disease Control and Prevention. 

Available from: https://www.cdc.gov/drugoverdose/data/prescribing.html. 

2. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid 

prescribing by race/ethnicity for patients seeking care in U.S. emergency 

departments. JAMA 299:70–8. 2008.

3. Kyriacou DN. Opioid vs nonopioid acute pain management in the 

emergency department. JAMA 318(17):1655–6. 2017.

4. National Center for Health Statistics. International classification of 

diseases, 10th revision, clinical modification (ICD–10–CM). Available from: 

https://www.cdc.gov/nchs/icd/icd10cm.htm.

5. National Center for Health Statistics. 2016 NHAMCS micro-data file 

documentation. Hyattsville, MD. 2018. Available from: ftp://ftp.cdc.gov/pub/

Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc16_ed.pdf. 

6. National Center for Health Statistics. 2016 NHAMCS micro-data set 

file. Hyattsville, MD. 2018. Available from: ftp://ftp.cdc.gov/pub/Health_

Statistics/NCHS/Datasets/NHAMCS/ED2016.zip.

7. Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez JF 

Jr, et al. National Center for Health Statistics data presentation standards for 

proportions. National Center for Health Statistics. Vital Health Stat 2(175). 

2017.

Keywords: pain • narcotic • National Hospital Ambulatory Medical Care 

Survey (NHAMCS)

Suggested Citation

Rui P, Schappert SM. Opioids prescribed 

at discharge or given during emergency 

department visits among adults in the United 

States, 2016. NCHS Data Brief, no 338. 

Hyattsville, MD: National Center for Health 

Statistics. 2019.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Jennifer H. Madans, Ph.D., Acting Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Health Care Statistics

Denys T. Lau, Ph.D., Director

Alexander Strashny, Ph.D., Associate 

Director for Science

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