Objectives Prescription opioid diversion is a significant contributor to the opioid misuse epidemic. We examined the quantity of opioids consumed by emergency department (ED) discharged patients after treatment for an acute pain condition (musculoskeletal, fracture, renal colic, abdominal pain and other), and the percentage of unused opioids available for potential misuse.
Design Prospective cohort study.
Setting Tertiary care trauma centre academic hospital.
Participants A convenience sample of patients ≥18 years who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day paper diary of daily pain medication use. To reduce lost to follow-up, participants also responded to standardised phone interview questions about their previous 14-day pain medication use.
Outcomes Quantity of morphine 5 mg tablets (or equivalent) prescribed, consumed and unused during a 14-day follow-up. Quantity of opioids to adequately supply 80% of patients for 2 weeks and 95% of patients for the first 3 days was also calculated.
Results Results for 627 patients were analysed (mean age ±SD: 51±16 years, 48% women). Patients consumed a median of seven tablets of morphine 5 mg (32% of the total prescribed opioids). The quantity of opioids to adequately supply 80% of patients for 2 weeks was 20 tablets of morphine 5 mg for musculoskeletal pain, 30 for fracture, 15 for renal colic or abdominal pain and 20 for other pain conditions. The quantity to adequately supply 95% of patients for the first 3 days was 15 tablets of morphine 5 mg.
Conclusions Patients discharged from the ED with an acute pain condition consumed a median of fewer than 10 tablets of morphine 5 mg (or equivalent). ED physicians should consider prescribing a smaller quantity of opioids and asking the pharmacist to dispense them in portions to minimise unused opioids.
Trial registration number NCT02799004; Results.
- pain management
- substance misuse
- acute pain
- emergency department
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Contributors RD and J-MC conceived the study and obtained research funding. All authors contributed to the final protocol and data interpretation. JP was responsible for data management and statistical analysis. RD drafted the manuscript, and AC, ÉP, JM, SG, MÉ, GL and JL contributed substantially to its revision. All authors approved the final manuscript as submitted and have agreed to be accountable for all aspects of the work.
Funding This study was supported by the Sacré-Coeur Hospital’s emergency medicine research fund.
Competing interests None declared.
Patient consent The research nurses obtained informed consent for study participation.
Ethics approval Approval was obtained from the local institutional ethics review board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Original data set found in the manuscript is available on request to the corresponding author.
Presented at Part of this study results have been presented at SAEM annual meeting, Orlando, Florida 2017.
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