RT Journal Article
SR Electronic
T1 Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E866
OP E874
DO 10.1503/cmaj.231640
VO 196
IS 25
A1 Daoust, Raoul
A1 Paquet, Jean
A1 Émond, Marcel
A1 Iseppon, Massimiliano
A1 Williamson, David
A1 Yan, Justin W.
A1 Perry, Jeffrey J.
A1 Huard, Vérilibe
A1 Lavigne, Gilles
A1 Lee, Jacques
A1 Lessard, Justine
A1 Lang, Eddy
A1 Cournoyer, Alexis
A1 
YR 2024
UL http://www.cmaj.ca/content/196/25/E866.abstract
AB 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: 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: 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 (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets).Interpretation: 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: ClinicalTrials.gov, no. NCT03953534.