PainRelief.com Interview with:

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

Response: Opioid prescriptions for acute pain have been identified as a possible factor in opioid epidemic mortality. The proposed causal model is that physicians provide opioid prescriptions for acute pain, which lead to prescription opioid misuse followed by illicit opioid use, subsequent overdose and death.

This paradigm has driven widespread describing initiatives, including the elimination of opioids from emergency care (“opioid free emergency departments”), but there is no research describing the link between an opioid prescription for acute pain and downstream opioid-related harm. 

Our objectives were to quantify for emergency patients filling an opioid prescription the likelihood of adverse outcomes as well as the incremental risk to opioid-treated patients vs. propensity-matched controls.

PainRelief.com: What are the main findings?

Response: We studied all emergency department patients treated in the province of Alberta over a 10-year period, comparing those who filled an opioid prescription to propensity-matched controls. We found that, during one-year follow-up, the risk of mortality, overdose and new opioid use disorder was the same for treated and untreated patients; however that opioid-treated patients had higher rates of all-cause hospitalization (16.4% vs. 15.1%) and subsequent prescription opioid use (4.5% vs. 3.3%). During the follow-up year, opioid-treated patients received 1.18 times as much opioid as controls. The incremental risk (potential iatrogenesis) was highest for opioid-naïve patients, older patients, and males. Patients with coexistent mental health or substance use disorder had high event rates with or without an opioid prescription, therefore suffered minimal incremental risk after opioid prescriptions.

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

Response: Our findings confirm that single opioid prescriptions are not risk free, but that the likelihood of harm is low and unlikely to outweigh the benefit of treating severe pain. They also demonstrate that patient characteristics influence risk. These data suggest that societal factors and other opioid sources play a larger causal role than emergency prescriptions.

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

Response: Future research should evaluate longer-term outcomes and explore the relationship between prolonged opioid use and health outcomes. Researchers should investigate agent-specific effects, as all opioids may not be equal, and should identify pain syndromes where opioid risk is greater or less than treatment benefit. Robust randomized trials are unlikely because of ethical concerns (randomizing patients with severe pain to non-opioid analgesia), selection bias (patients of greatest interest selecting out), loss to follow-up, and the large sample sizes required to detect small outcome differences. We suggest that observational and quasi-experimental studies in large populations will be more fruitful, and will provide valuable knowledge if well performed.

Any disclosures? No significant conflicts of interest and no commercial or industry involvement in the study.

Citation:

Effect of emergency department opioid prescribing on health outcomes
Jake Hayward, Rhonda J. Rosychuk, Andrew D. McRae, Aynharan Sinnarajah, Kathryn Dong, Robert Tanguay, Lori Montgomery, 
Andrew Huang, Grant Innes
CMAJ Feb 2025, 197 (5) E122-E130; DOI: 10.1503/cmaj.241542

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Last Updated on February 11, 2025 by PainRelief.com