CMAJ Study Suggests Clinicians Adapt Opioid Prescriptions to Specific Types of Acute Pain

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PainRelief.com Interview with:
Raoul Daoust MD CSPQ MSc
Professeur titulaire/ full professor
Département Médecine de Famille et Médecine d’Urgence
Université de Montréal
Clinicien chercheur / Clinician Researcher
Médecine d’Urgence / Emergency Medicine
CEMU-HSCM (Centre d’Étude en Médecine d’Urgence)
SCEM-HSCM (Study Center in Emergency Medicine)
Hôpital Sacré-Coeur de Montréal
CIUSSS Nord-de-l’ile

PainRelief.com: What is the background for this study?

Response: Overprescribing is linked to opioid misuse and overdose, with household supplies of opioids associated with an increased risk of overdose as many people do not dispose of unused medications safely. In Canada, more than 7570 people died of opioid overdoses in 2021, and more than 68 000 people died in the United States in 2020 from these same drugs.

PainRelief.com: What are the main findings?

Response: Half of the 2240 emergency department patients received a prescription of 16 tablets or more after their discharge for an acute pain and 63% of these tablets were not used during a two-week follow-up. Consumption of opioids was low, half of patients consumed fewer than 5 tablets, and varied significantly by types of pain. To alleviate pain in 80% of patients for two weeks, clinicians should prescribe 8 morphine 5mg equivalent tablets for kidney or abdominal pain, 16 for musculoskeletal pain, 21 for back pain, and 24 for fractures.

PainRelief.com: What should readers take away from your report?

Response: Clinicians prescribe opioids in quantities that exceed the needs for acute pain, resulting in a majority of these medications being left unused.

Clinicians should adapt their opioid prescriptions to the specific types of acute pain conditions. To further reduce the availability of unused opioids for misuse, they should instruct pharmacists to dispense half the prescribed quantity at a time. Additionally, clinicians should include an expiry date on the prescription to limit its use to the current painful condition (e.g., 3, 7, or 14 days)

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response: In a future study, test the impact on unused pain medication of these new opioid prescribing recommendations for acute pain.

Disclosures: This study was funded by a CIHR grant.

Citation: Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study

Raoul Daoust, Jean Paquet, Marcel Émond, Massimiliano Iseppon, David Williamson, Justin W. Yan, Jeffrey J. Perry, Vérilibe Huard, Gilles Lavigne, Jacques Lee, Justine Lessard, Eddy Lang and Alexis Cournoyer; for the Quantity of Opioids for Acute Pain and Limit Unused Medication (OPUM) group on behalf of the Network of Canadian Emergency Researchers

CMAJ July 15, 2024 196 (25) E866-E874; DOI: https://doi.org/10.1503/cmaj.231640

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Last Updated on July 15, 2024 by PainRelief.com