ED Opioid Prescriptions: Gateway or Just an Indicator of Pain?

This is for our providers who treat chronic pain.

Published in Ann Emerg Med 2014 Dec 17

Authors: Hoppe JA et al.

Patients filling opioid prescriptions from an emergency department visit for pain are nearly twice as likely to receive future opioid prescriptions as patients not prescribed opioids at the visit.

To elucidate the patterns of opioid use after an emergency department (ED) visit for pain, investigators retrospectively compared future opioid prescriptions between patients who received and filled an opioid prescription from the ED and patients who did not receive an opioid prescription.

Among 2499 opioid-naive patients who presented to a single urban academic ED with acute pain during a 5-month period, 1079 (43%) received an opioid prescription at the visit and 775 filled it. Within 10 to 14 months after the visit, an opioid prescription was filled by 17% of those 775 patients versus 10% of 1420 patients who did not receive a prescription at the initial visit (adjusted odds ratio for recurrent use, 1.8).

Comment
We are in the midst of an epidemic of prescription opioid abuse, and research designed to predict who will go on to be an abuser is very important. Even though recent evidence shows that disproportionate numbers of opioid prescriptions are written by emergency physicians, we would interpret the current study’s results cautiously, because it does not provide any evidence for whether patients who received a later opioid prescription were abusers or really needed the medicine. Opioid prescribing is a delicate balance between oligoanalgesia (a well-documented problem) and fueling the fire of abuse. Nonetheless, prescription monitoring program databases should be used when available, and the lowest medically reasonable dose of opioids, with the fewest number of pills, should be prescribed.