Although rarely indicated, opioids are being prescribed at an uncommonly high rate for patients with ankle sprains, according to a report from Michigan Medicine published online by Annals of Internal Medicine.
“The opioid epidemic is well documented in this country,” said James R. Holmes, MD, foot and ankle service chief and an associate professor of orthopaedic surgery at Michigan Medicine in Ann Arbor. “Physician prescribing and over-prescribing is part of the problem.”
To determine the rate of opioid prescribing for patients with an ankle sprain injury, Dr. Holmes and his colleagues examined data from a health insurance claims database. They found that of the nearly 592,000 patients diagnosed with an ankle sprain during the selected 9-year period, 11.9% filled an opioid prescription within 7 days of diagnosis.
“When we selected out opioid-naïve individuals, or individuals who had not had an opioid prescription during the year before the sprain, 8.4% of these individuals were still filling a prescription for an opioid 3 months after the original diagnosis,” Dr. Holmes said.
Even more alarming, opioids have never been included in treatment recommendations for ankle sprains.
“Several evidence-based recommendations for the treatment of ankle sprains exist and include treatments such as cryotherapy, non-steroidal anti-inflammatory drugs, functional support, and exercise,” Dr. Holmes said. “No evidence-based treatment guidelines for ankle sprains include prescribing opioids.”
The study notes that most prescriptions were provided by physicians and advanced practice providers in emergency medicine and primary care settings.
“A recent study  showed that approximately 25% of patients with ankle sprains presenting to hospital emergency departments received an opioid prescription,” Dr. Holmes said.
“It’s important for all physicians to understand ankle sprain treatment guidelines and the fact that initial opioid prescription seems to be linked to new persistent opioid use; in this particular study, 8.4% of individuals.”
Finney FT, Gossett TD, Hu HM, et al. Rate of opioid prescriptions for patients with acute ankle sprain. Ann Intern Med. 2019 Jul 9. doi: 10.7326/M19-0679. [Epub ahead of print]
- Delgado M, Huang Y, Meisel Z, et al. National variation in opioid prescribing and risk of prolonged use for opioid-naive patients treated in the emergency department for ankle sprains. Ann Emerg Med. 2018 Oct;72(4):389-400.e1. doi: 10.1016/j.annemergmed.2018.06.003. Epub 2018 Jul 24.