What question did this study set out to answer?

To explore changes in opioid prescribing rates and subsequent harms among adolescents in Alberta over a decade.

April 25, 2026

Emergency Department Prescribing and Opioid-Related Harms Among Adolescents in Alberta: 2010-2020

HLHenry LiAlberta Health Services SASamina AliUniversity of Alberta JHJessalyn K. Holodinsky

Key Points

To explore changes in opioid prescribing rates and subsequent harms among adolescents in Alberta over a decade.
Cohort study using linked administrative data for patients aged 12 to 17 from Alberta's EDs between 2010 and 2020.
Included opioid prescription fills within 3 days of ED visit and tracked opioid-related harms over one year.
Utilized Joinpoint regression to identify trends in prescribing and harm rates.
ED opioid prescribing declined from 3.3% in 2010 to 1.2% in 2020, with notable decreases in codeine and oxycodone.
Opioid-related harms surged from 0.15% in 2010 to 0.28% in 2020, indicating an alarming trend despite the reduced prescribing rate.
General EDs prescribed more opioids than pediatric EDs (2.5% vs 1.5%) and exhibited slower decreases over the study period.

Abstract

BACKGROUND AND OBJECTIVES Although emergency department (ED) prescribing is targeted as a potential contributor to opioid-related harms, the impact of efforts to curb prescribing and subsequent harms are poorly understood. We examined how rates of ED opioid prescribing and subsequent opioid-related harms have changed over time among adolescents. METHODS We conducted a cohort study using linked administrative data sets of patients aged 12 to 17 years who were discharged from any ED in Alberta, Canada, from April 1, 2010, to June 30, 2020. Opioid prescription fills in the 3 days after an ED visit were included. Our primary outcome was the development of opioid-related harms: a 1-year composite of opioid-related ED visit, opioid-related hospitalization, and opioid agonist therapy prescription. Joinpoint regression was used to identify changes in rates. RESULTS Among 1 197 829 ED visits, ED opioid prescribing decreased from 3.3% of visits in 2010 to 1.2% in 2020; specifically, codeine and oxycodone prescribing decreased while tramadol and other opioid prescribing increased. General EDs prescribed more opioids than pediatric EDs (2.5% vs 1.5%) and saw slower decreases over time. The development of opioid-related harms increased from 0.15% in 2010 to 0.28% in 2020. CONCLUSIONS During a decade when ED opioid prescribing to adolescents decreased substantially, subsequent opioid-related harms nearly doubled in Alberta. Broad deprescribing measures in the ED may not effectively combat the opioid epidemic in this province. However, caution should remain for patients with longer prescription durations, frequent ED use, and mental health or substance use comorbidity and further studies are needed to better delineate patient-level risk.

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