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Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study
  1. Raoul Daoust1,2,
  2. Jean Paquet1,
  3. Alexis Cournoyer1,2,
  4. Éric Piette1,2,
  5. Judy Morris1,2,
  6. Sophie Gosselin3,
  7. Marcel Émond4,5,
  8. Gilles Lavigne6,7,
  9. Jacques Lee8,
  10. Jean-Marc Chauny1,2
  1. 1 Department of Emergency Medicine, Research Centre, CIUSSS-Nord-de-l’Île de-Montréal, Sacré-Coeur Hospital, Québec, Canada
  2. 2 Département Médecine Familliale et Médecine d’Urgence, Faculté de Médecine, Université de Montréal, Québec, Canada
  3. 3 Department of Emergency Medicine, McGill University Health Centre, McGill University, Québec, Canada
  4. 4 Département de Médecine d’urgence et Famille, Faculté de Médecine, Université Laval, Québec, Canada
  5. 5 Département d’urgence du CHU-Québec, Université Laval, Québec, Canada
  6. 6 Faculties of Dental Medicine and Medicine, Université de Montréal, Québec, Canada
  7. 7 Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l’Île-de-Montréal), Québec, Canada
  8. 8 Department of Emergency Services and Scientist, Clinical Epidemiology Unit, Sunnybrook Health Sciences, Ottawa Hospital Research Institute, Toronto, Ontario, Canada
  1. Correspondence to Dr Raoul Daoust; raoul.daoust{at}videotron.ca

Abstract

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
  • opioids
  • acute pain
  • emergency department

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • 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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