1% of Patients Given Opioids in ED for Acute Pain Develop OUD

[drusso]

Ann Emerg Med. 2019 Nov 1. pii: S0196-0644(19)31134-5. doi: 10.1016/j.annemergmed.2019.08.446. [Epub ahead of print]
Opioid Use During the Six Months After an Emergency Department Visit for Acute Pain: A Prospective Cohort Study.
Friedman BW1, Ochoa LA2, Naeem F3, Perez HR4, Starrels JL4, Irizarry E2, Chertoff A2, Bijur PE2, Gallagher EJ2.
Author information
1Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY. Electronic address: [email protected].2Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.3Medical College, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.4Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
Abstract
STUDY OBJECTIVE:
Despite the frequent use of opioids to treat acute pain, the long-term risks and analgesic benefits of an opioid prescription for an individual emergency department (ED) patient with acute pain are still poorly understood and inadequately quantified. Our objective was to determine the frequency of recurrent or persistent opioid use during the 6 months after the ED visit METHODS: This was a prospective, observational cohort study of opioid-naive patients presenting to 2 EDs for acute pain who were prescribed an opioid at discharge. Patients were followed by telephone 6 months after the ED visit. Additionally, we reviewed the statewide prescription monitoring program database. Outcomes included frequency of recurrent and persistent opioid use and frequency of persistent moderate or severe pain 6 months after the ED visit. Persistent opioid use was defined as filling greater than or equal to 6 prescriptions during the 6-month study period.
RESULTS:
During 9 months beginning in November 2017, 733 patients were approached for participation. Four hundred eighty-four met inclusion criteria and consented to participate. Four hundred ten patients (85%) provided 6-month telephone data. The prescription monitoring database was reviewed for all 484 patients (100%). Most patients (317/484, 66%; 95% confidence interval 61% to 70%) filled only the initial prescription they received in the ED. One in 5 patients (102/484, 21%; 95% confidence interval 18% to 25%) filled at least 2 prescriptions within the 6-month period. Five patients (1%; 95% confidence interval 0% to 2%) met criteria for persistent opioid use. Of these 5 patients, all but 1 reported moderate or severe pain in the affected body part 6 months later.
CONCLUSION:
Although 1 in 5 opioid-naive ED patients who received an opioid prescription for acute pain on ED discharge filled at least 2 opioid prescriptions in 6 months, only 1% had persistent opioid use. These patients with persistent opioid use were likely to report moderate or severe pain 6 months after the ED visit.
Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
PMID: 31685253 DOI: 10.1016/j.annemergmed.2019.08.446

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[lobelsteve]

So you are saying 99% of those studied do not develop OUD? Is OUD defined as taking opiates? 733 approached. 430 or so studied. How many were taking opiates without an RX.
This does not fit the current narrative. It also excludes current opiate users.

 

[drusso]

So you are saying 99% of those studied do not develop OUD? Is OUD defined as taking opiates? 733 approached. 430 or so studied. How many were taking opiates without an RX.
This does not fit the current narrative. It also excludes current opiate users.

Convince yourself of these two facts, hold them in your mind simultaneously, and you will be smarter than most people making pain treatment guidelines:

"75% of heroin users initiate their opioid use with pills."

**AND**

"1% of patients in the ED prescribed opioids go onto to use them persistently."

 

[lobelsteve]

Ask yourself where those 75% of heroin addicts got their start.

Was it from a pain physician after due diligence and risk assessment?
Was it from the dodo PCP or ER- the audience for the article?
Or was it stolen meds from friends and family?

This is not a simple problem. But is has a simple solution.

 

[Ducttape]

using numbers such as 1% do not justify your arguments when you look at the proper scale.

for example: 1% of 136,000,000 ER visits is what.... 1,360,000 people.

suppose that only 1 of 10 people visiting the ER get a prescription for opioids afterwards.

using this data, you are still talking about 136,000 new people yearly who will start chronic opioid use just from the ER.

 

[lobelsteve]

I treat patients. I am not MPH. These are not my patients.
ER should not be Rx opiates. Treat'em and street'em. Or admit.

 

[VA Hopeful Dr]

I treat patients. I am not MPH. These are not my patients.
ER should not be Rx opiates. Treat'em and street'em. Or admit.

Nonsense.

Fractures don't always get admitted. Neither do kidney stones. Both can be a justified use of opiates.

They should be used very judiciously, and that is what I suspect we're all seeing compared to 10 years ago.

Same with us PCP types - we shouldn't use opiates often but there are times it's appropriate.

 

[Baron Samedi]

"75% of heroin users initiate their opioid use with pills."

Yes, but also, somewhat surprisingly, only 4% of pill abusers go on to use heroin. Most pill abusers stay on pills.