# Opioid Prescribing Behavior in Emergency Settings and Associated Risk Factors in the Central Region of the Kingdom of Saudi Arabia

## TL;DR

This study explores how emergency physicians in Saudi Arabia prescribe opioids, finding that younger and less experienced doctors are more likely to prescribe them based on clinical factors.

## Contribution

The study identifies clinical factors and demographic trends influencing opioid prescribing in Saudi emergency settings, emphasizing the need for targeted education.

## Key findings

- Younger physicians and those with 1-2 years of experience had higher opioid prescribing scores.
- Clinical factors like prior analgesic use and pain severity strongly influenced opioid prescriptions.
- Fewer years since graduation significantly predicted higher opioid prescribing scores.

## Abstract

Background: Pain management is an important issue in emergency medicine. Although opioids have many associated adverse effects, including opioid misuse and dependence, they are still frequently prescribed nowadays. Subsequently, it is vital to understand the factors influencing opioid prescribing decisions among emergency physicians. This article aims to examine factors affecting opioid prescribing behaviors among emergency physicians in Saudi Arabia and assess attitudes impacting prescribing practices.

Methods: A cross-sectional study was performed in the period from February 2024 to February 2025 among 213 emergency physicians in Saudi Arabia. The clinical, external, and psychosocial factors affecting opioid prescribing decisions were evaluated using a 22-item Likert-scale questionnaire. Descriptive, bivariate, and multivariable regression analyses were used to explore the relationship of demographic, regional, and professional data with predictors of prescribing behaviors.

Results: Our study included 213 emergency physicians, with the majority (62.4%, n=133) aged between 23 and 30 years. While 72.8% (n=155) of participants were male, female physicians represented 27.2% (n=58) of the sample. The analysis revealed that younger physicians, as well as people with one to two years of experience after post-graduation, had a higher opioid prescribing score (OPS). Prior analgesic use, pain severity, and physical examination findings were the most common clinical factors. No significant associations were found for age, gender, practice level, or region. Male physicians showed slightly higher OPS than female physicians (B = 2.53, p = .167, 95%CI -1.07, 6.13). However, the association was not statistically significant. Physicians working more than 16 shifts per month also demonstrated a non-significant trend toward higher OPS compared to those with 12 or fewer shifts (B = 4.91, p = .086, 95%CI -0.71, 10.53). In contrast, fewer years since graduation significantly predicted higher OPS (β = -7.81, p = 0.029) in the multivariable regression. Additionally, gender, practice level, or region revealed no significant differences.

Conclusion: Emergency physicians with fewer years of experience and younger ages are more willing to prescribe opioids mainly directed by clinical causes in Saudi Arabia. These findings call for more focused educational interventions and standardized guidelines in order to promote safe opioid use and reduce potential overprescribing behavior within society.