A Prospective Cohort Study to Determine Which Opioid-Naïve Emergency Department Patients Are at Risk of Persistent Opioid Use - 18/07/25
Abstract |
Study objective |
It is unclear which opioid-naïve emergency department (ED) patients prescribed an opioid progress to opioid use disorder. We tested the hypothesis that opioid-induced euphoria and persistent pain 2 weeks after an ED visit would be associated with persistent prescribed opioid use among opioid-naïve ED patients who presented to the ED with pain and were discharged with an opioid prescription.
Methods |
This was a prospective cohort study. We enrolled patients during an ED visit and followed them by telephone 48 hours, 2 weeks, and 6 months later. We also reviewed the state prescription monitoring database at 6 months. Persistent opioid use was defined as ≥1 opioid prescription/month after ED discharge. At 48 hours, participants were asked: How much euphoria, joy, or happiness did the opioid medication give you? and how much would you like to use the medication again? Each of these was assessed on a 0 to 10 scale. Pain was measured with a 4-item ordinal scale: severe, moderate, mild, or none.
Results |
A total of 699 patients were eligible for participation and enrolled. Of these, 17/699 (2%) developed new-onset persistent opioid use. Median feeling euphoria, joy, or happiness was 0 (interquartile range [IQR]: 0, 0); median like to use again was 6 (IQR: 0, 10). A total of 296/256 (45%) reported moderate or severe pain in the affected area at 2 weeks. Neither euphoria/joy/happiness (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.61 to 1.15) nor take again (OR 1.06, 95% CI 0.92 to 1.21) was associated with persistent opioid use. Moderate or severe pain was associated with persistent opioid use (OR 5.15, 95% CI 1.43 to 18.50).
Conclusion |
Persistence of pain 2 weeks later but not opioid-induced euphoria is associated with progression to persistent prescribed opioid use. If validated, these data would allow an integrated health care system to identify patients at risk of progression.
Le texte complet de cet article est disponible en PDF.Keywords : Opioid-induced euphoria, Persistent opioid use, Pain, Oxycodone, Codeine
Plan
| Please see page 180 for the Editor’s Capsule Summary of this article. |
|
| Supervising editor: Lewis S. Nelson, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
|
| Author contributions: LA, EI, BWF conceived the study and designed the trial. MT, MD, KS, JB, GM, CG, VA, EI, BWF supervised the conduct of the trial and collected data. EI, BWF managed the data, including quality control. LA, LG, FP, BWF analyzed the data. LA, LG, FP drafted the manuscript, and all authors contributed substantially to its revision. BWF takes responsibility for the paper as a whole. |
|
| Data sharing statement: Deidentified data are available from the corresponding author. |
|
| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
|
| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). This publication was supported in part by the Harold and Muriel Block Institute for Clinical and Translational Research at Einstein and Montefiore grant support (UM1TR004400). The authors have declared that no competing interests exist. |
|
| Readers: click on the link to go directly to a survey in which you can provide D8S62KS to Annals on this particular article. |
Vol 86 - N° 2
P. 179-186 - août 2025 Retour au numéro
Article précédent
- Clinical Policy: Critical Issues in the Management of Adult Patients Requiring Endotracheal Intubation in the Emergency Department
- American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Airway Management, Steven A. Godwin, Sigrid A. Hahn, Benjamin W. Friedman, Bradley Shy, Sean M. Hickey, Stephen P. Wall, Stephen J. Wolf, Deborah B. Diercks, Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee), Deborah B. Diercks, John D. Anderson, Richard Byyny, Christopher R. Carpenter, Seth R. Gemme, Charles J. Gerardo, Steven A. Godwin, Sigrid A. Hahn, Benjamin W. Hatten, Jason S. Haukoos, Amy Kaji, Heemun Kwok, Bruce M. Lo, Sharon E. Mace, John Thompson, Susan B. Promes, Kaushal H. Shah, Richard D. Shih, Scott M. Silvers, Andrea Slivinski, Michael D. Smith, Molly E.W. Thiessen, Christian A. Tomaszewski, Stacy Trent, Jonathan H. Valente, Stephen P. Wall, Lauren M. Westafer, Yanling Yu, Stephen V. Cantrill, John T. Finnell, Travis Schulz, Kaeli Vandertulip
- Upper Respiratory Infections and Respiratory Adverse Events and Interventions in Emergency Department Sedation of Children
- Daniel S. Tsze, Nick Barrowman, Maala Bhatt
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?