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Opioid Use During the Six Months After an Emergency Department Visit for Acute Pain: A Prospective Cohort Study

      Study objective

      Despite the frequent use of opioids to treat acute pain, the long-term risks and analgesic benefits of an opioid prescription for an individual emergency department (ED) patient with acute pain are still poorly understood and inadequately quantified. Our objective was to determine the frequency of recurrent or persistent opioid use during the 6 months after the ED visit

      Methods

      This was a prospective, observational cohort study of opioid-naive patients presenting to 2 EDs for acute pain who were prescribed an opioid at discharge. Patients were followed by telephone 6 months after the ED visit. Additionally, we reviewed the statewide prescription monitoring program database. Outcomes included frequency of recurrent and persistent opioid use and frequency of persistent moderate or severe pain 6 months after the ED visit. Persistent opioid use was defined as filling greater than or equal to 6 prescriptions during the 6-month study period.

      Results

      During 9 months beginning in November 2017, 733 patients were approached for participation. Four hundred eighty-four met inclusion criteria and consented to participate. Four hundred ten patients (85%) provided 6-month telephone data. The prescription monitoring database was reviewed for all 484 patients (100%). Most patients (317/484, 66%; 95% confidence interval 61% to 70%) filled only the initial prescription they received in the ED. One in 5 patients (102/484, 21%; 95% confidence interval 18% to 25%) filled at least 2 prescriptions within the 6-month period. Five patients (1%; 95% confidence interval 0% to 2%) met criteria for persistent opioid use. Of these 5 patients, all but 1 reported moderate or severe pain in the affected body part 6 months later.

      Conclusion

      Although 1 in 5 opioid-naive ED patients who received an opioid prescription for acute pain on ED discharge filled at least 2 opioid prescriptions in 6 months, only 1% had persistent opioid use. These patients with persistent opioid use were likely to report moderate or severe pain 6 months after the ED visit.
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      Linked Article

      • Opioid Prescribing From the Emergency Department: Number Needed to Harm Must Account for the Magnitude of Benefits and Harms
        Annals of Emergency MedicineVol. 75Issue 5
        • Preview
          Friedman et al1 prospectively identified opioid-naive patients being discharged with an opioid prescription and determined the number of opioid prescriptions filled by each subject during the following 6 months by self-report and by querying the New York State prescription drug monitoring database. Although we agree that the substantial progress that has been made is to be celebrated, we are concerned about how the study’s results are interpreted and presented.
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      • In reply:
        Annals of Emergency MedicineVol. 75Issue 5
        • Preview
          Our thanks to Drs. Strayer and Nelson for their thoughtful response to our research article.1 We hope that emergency physicians use our data to make informed prescribing decisions and to counsel emergency department (ED) patients about the risks of opioids.
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