A quarter of the adults who went to hospital emergency departments with sprained ankles were prescribed opioid painkillers, a new study shows, in another sign of how commonly physicians turn to narcotics even for minor injuries.

The state-by-state review revealed wide variation in the use of opioids for the sprains, from 40 percent in Arkansas to 2.8 percent in North Dakota. All but one of the nine states that recorded above-average opioid prescribing are in the South or Southwest.

The analysis of 30,832 private insurance claims from 2011 to 2015 revealed that emergency department prescriptions can influence long-term opioid use. The median prescription was 15 tablets, or three days’ worth of hydrocodone, oxycodone, tramadol or other narcotics. Patients who received the largest amounts were five times as likely to continue with prolonged opioid use than those given 10 tablets or fewer, though their overall numbers were relatively small. The recipients were not known to have previously used opioids.

Opioid prescriptions written by emergency room doctors are responsible for a small portion of the vast amount of narcotic painkillers consumed by patients each year. Most prescriptions come from primary-care physicians.

The study looked at prescriber habits shortly before CDC issued guidelines that urged doctors to use opioids sparingly, and before many states and the federal government moved to limit the length of first-time opioid prescriptions.

“There was this leap to opioids, either in perception of patient expectations or to meet patient expectations,” said Kit Delgado, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania’s Perelman School of Medicine.

Delgado speculated that doctors offered opioids because their medical training did not warn about addiction. The research was published last week in the journal Annals of Emergency Medicine.

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