Emergency departments likely overprescribing opioids for acute pain

1. In this cohort study, majority of the participants did not use all of the opioids prescribed to them in the emergency department (ED) implicating that doctors working in the ED can lower the number of opioids prescribed. 

Evidence Rating Level: 1 (Excellent)

In 2020, tens of thousands of people died from opioid overdoses in the United States while some other few thousand died in Canada in 2021, with numbers expected to rise in both countries. The emergency department has played a large role in providing individuals with opioids, and among the individuals that received their first opioids from a legal prescription, 20% were prescribed in the emergency department. The purpose of this study was to understand the prime dose for an opioid prescription that will decrease the patient’s pain while limiting the quantity of opioids prescribed in the emergency department. Recruitment took place between May 2019 and January 2023 with a pause between March to October 2020 due to the COVID-19 pandemic. The patients responded to a questionnaire for demographics and recorded their pain medication intake into a diary for 14 days. Research assistants also interviewed the participants over the phone to ensure complete data collection. All of these methods were used to evaluate the main outcome, quantity of opioid tablets consumed during the 14-day follow-up period. To match up all the opioids into the same measurements for comparison purposes, each prescription was converted into morphine 5 mg tablet equivalents. After screening, 2240 participants, with a mean age 51 (SD ± 16) years were included. During the follow-up period, majority (93%; n = 2074) of the patients filled their prescribed opioid medication, and overall reported using a median number of 5 morphine 5 mg tablet equivalents. The pain levels varied depending on the condition (p<0.001) with the lowest pain reported in patients with renal colic or abdominal pain, while the highest pain was reported in patients with musculoskeletal pain. In total, 63% of the prescribed opioids were unused among the 2240 patients. Overall, the number of opioids needed varied for different conditions, although majority of the patients had a low (5 morphine 5 mg tablet equivalent) use of opioids in general. These results can help physicians lower the amount of opioids they prescribe, while still ensuring their patient’s pain is well managed. 

Click to read the study in CMAJ

Image: PD

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