BACKGROUND: The relation between emergency department opioid prescribing and subsequent harm is complex and poorly studied. We sought to quantify adverse outcomes, incremental risk, and rates of prolonged opioid use among emergency department patients receiving an opioid prescription and propensity-matched controls.
METHODS: We used administrative data to sample all Alberta emergency department visits over 10 years, excluding patients with cancer, palliative care, or concurrent opioid use. Treated patients filled an opioid prescription within 72 hours after their index visit; untreated patients did not. We generated propensity scores to identify matched controls among untreated patients. The 1-year primary composite outcome included opioid-related emergency visits (e.g., overdoses), new opioid agonist therapy, all-cause hospital admission, or death. The secondary outcome was prolonged opioid use.
RESULTS: After 13 028 575 eligible visits, 689 074 patients (5.3%) filled an opioid prescription. The mean age was 43.9 years, and 49.8% of patients were female. Most were high-acuity patients with traumatic, gastrointestinal-genitourinary, or musculoskeletal complaints. Patients who received opioids experienced 1.4% more primary outcome events (17.1% v. 15.7%), driven by all-cause hospital admissions (16.4% v. 15.1%; number needed to harm [NNH] = 53) and prolonged opioid use (4.5% v. 3.3%; NNH = 59). Opioid-related visits, new opioid agonist treatment, and mortality were unaffected. Incremental risk was low for patients with documented mental health conditions or substance use, and was highest for opioid-naive patients, older patients, and males.
INTERPRETATION: Emergency department opioid prescriptions were associated with small increases in subsequent opioid prescription use and hospital admission, particularly in older and opioid-naive patients, and males; they were not associated with overdoses, new opioid agonist therapy, or mortality. Physicians should understand patient-specific incremental risks when prescribing opioids for acute pain.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Nurse | |
Nurse rater
The abstract does not include the vital piece of information that this data pertains to Canadian facilities only.
Physician rater
Adds to the abundant evidence that opioid treatment in ED should be avoided whenever possible.
Physician rater
This study assesses the impact of Emergency Department (ED) opioid prescriptions and subsequent opioid prescriptions. This study showed a small increase in subsequent opioid prescription use and hospital admission. This information is important and should be considered when prescribing opioids in the ED.
Physician rater
The prescribing of opioids in my ED practice has gone way down, but this is good info to have about knowing your patient population.
Physician rater
A well designed study that looked at Emergency Department opioid prescriptions and subsequent adverse effects. They controlled for many factors available to them, but current opioid risk calculators suggest other factors they were unable to control for, such as family history of substance abuse and a history of preadolescent sexual abuse. They did find excess risk associated with age > 65 and opioid naive status, which led to an increase in subsequent hospitalization and prolonged opioid use. The other interesting finding was a reduction in risk over time from 2010 to 2020, likely reflecting decreased opioid prescribing, but they didn't measure duration of therapy or number of pills prescribed, etc.
Physician rater
Interesting study. Opioid prescriptions were associated with a small increases in subsequent opioid prescription use and hospital admission. However, hospital admissions were not related to opioid use.
Physician rater
Opioid dependence is currently a global issue. If used in the Emergency Department, risks must be assessed and monitored. This article largely affects older children and college students.
Physician rater
This study evaluated ER opioid prescriptions by analyzing more than 13M ED visits, of which ~700K filled a narcotic prescription (~5%.) The most common reasons for prescribing were musculoskeletal pain, GI pain, and trauma. Patients with cancer, under palliative care, or already using opioids were not included in the analysis. There was very little harm. All-cause hospital admissions and prolonged opioid use were the main harms, occurring nearly as frequently in persons receiving opioids and non-opioids (17.1% vs 15.6%). Opioid-related visits, new opioid prescriptions, and mortality were unaffected. Bottom line: opioid prescriptions from the ED seen pretty rare and cause little harm. More work needs to be done on other pain control agents/modalities and the utility of opioids for acute pain control, given that these effects occur at the CNS level.
, McMaster University