Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study.
Humans
Analgesics, Opioid
/ therapeutic use
Female
Male
Emergency Service, Hospital
Middle Aged
Acute Pain
/ drug therapy
Prospective Studies
Adult
Aged
Drug Prescriptions
/ statistics & numerical data
Abdominal Pain
/ drug therapy
Renal Colic
/ drug therapy
Practice Patterns, Physicians'
/ statistics & numerical data
Fractures, Bone
Back Pain
/ drug therapy
Emergency Room Visits
Journal
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
ISSN: 1488-2329
Titre abrégé: CMAJ
Pays: Canada
ID NLM: 9711805
Informations de publication
Date de publication:
14 Jul 2024
14 Jul 2024
Historique:
accepted:
16
04
2024
medline:
16
7
2024
pubmed:
16
7
2024
entrez:
15
7
2024
Statut:
epublish
Résumé
Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids. In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period. We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions ( Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse. ClinicalTrials.gov, no. NCT03953534.
Sections du résumé
BACKGROUND
BACKGROUND
Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids.
METHODS
METHODS
In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period.
RESULTS
RESULTS
We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (
INTERPRETATION
CONCLUSIONS
Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov, no. NCT03953534.
Identifiants
pubmed: 39009368
pii: 196/25/E866
doi: 10.1503/cmaj.231640
doi:
Substances chimiques
Analgesics, Opioid
0
Banques de données
ClinicalTrials.gov
['NCT03953534']
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E866-E874Informations de copyright
© 2024 CMA Impact Inc. or its licensors.
Déclaration de conflit d'intérêts
Competing interests:: Justin Yan reports receiving funding from the Spring 2021 Innovation Fund from the Academic Medical Organization of Southwestern Ontario, and the 2021 Internal Research Fund for Pilot Studies from the Lawson Health Research Institute. Dr. Yan has also served as the chair of the data safety monitoring boards of the RAFF4 Study and the REMOSYNCED Study, and vice-chair of the Canadian Association of the Emergency Physicians Research Committee. Jeffrey Perry reports receiving a peer review salary support grant from the Heart and Stroke Foundation of Ontario. Gilles Lavigne reports receiving consulting fees from Straumann Suisse related to a sleep bruxism device, and an oral appliance for sleep apnea from Panthera Dental. Dr. Lavigne is also a board member of the Canadian Academy of Health Sciences. No other competing interests were declared.