Opioid Prescriptions: Pain Relief Today, More Hospital Visits Tomorrow

Prescribe with Caution: Emergency Department opioids may relieve pain but leave a lasting mark.

Opioid prescriptions from the emergency department (ED) led to slight increases in future opioid use and hospital visits, reports a new study.

The findings of the study are published in the (Canadian Medical Association Journal (CMAJ) ().

Prescription Drug Abuse
Prescription drug abuse is consuming prescription medications in a way different from that as prescribed by the doctor. It is becoming a colossal health problem which can lead to addiction and even death.

‘One prescription doesn’t fit all—Opioids require caution. #opioidprescription #emergencydepartment #medindia’

Opioids in the Emergency Department: Necessary Relief or Future Burden?

To understand the relationship between opioid prescribing in the ED and subsequent harm, researchers looked at opioid prescribing at all Alberta EDs from 2010 to 2020. Of the more than 13 million visits, 689 074 patients (5.3%) filled an opioid prescription. The researchers found that opioid prescriptions did not increase the risk of death or overdose, but that opioid-treated patients were more likely than untreated controls to require a hospital admission (16.4% v. 15.1%) or to receive additional opioid prescriptions (4.5% v. 3.3%) in the year following the ED visit.

Study: 48.9% Increase in Opioid-related Hospital Admissions
Opioid-related admissions spiked by 48.9% from 10,805 admissions in 2008 to 16,091 admissions in 2018, with a total treatment cost of £137 million.

Managing Pain in an Era of Opioid Limits

“Emergency physicians face growing pressure to curtail opioid prescribing but must manage severe pain and treat opioid-tolerant patients who can no longer access opioids from their physicians,” writes Dr. Grant Innes, professor of emergency medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, with coauthors. “There is little research to guide them.”

Opioid Pain Medications Increase Risk of Bone Fractures, Delay Fracture Healing
Opioid or narcotic pain medications, may increase the risk of bone fractures and also affect the fracture repair process found a study on common bone fractures.

Single Opioid Prescriptions: Safe for Most, Risky for Some

The researchers concluded that although single opioid prescriptions are not risk free, the likelihood of harm is low and unlikely to outweigh the benefit of treating severe pain. Their findings also show that patient characteristics influence risk and that adverse outcomes are more likely with opioid-naive patients, older patients, patients with multiple health conditions, and frequent ED users.

Telehealth Linked to Reduced Opioid Overdose Risk
During the pandemic, the extended use of telehealth for opioid use disorder is linked to decreased risk of overdose.

Pain Fades, Risks Remain: The Lasting Impact of Emergency Department Opioid Prescriptions

“Physicians should understand the concept of patient-specific incremental risks when prescribing opioids for acute pain and prescribe cautiously within high-risk groups,” the authors conclude.

They also suggest that future research should investigate the effects of different opioid drugs, which may not be equal, and identify health conditions where opioid risk is more or less severe.

“Research and guidance in this area is long overdue, and only filling this research gap will allow acute pain prescribers and their patients to consider how best to ameliorate pain while minimizing potential harms related to opioid prescription,” writes Dr. Donna Reynolds, a family physician and acting co-chair of the Canadian Task Force on Preventive Health Care.

Reference:

Effect of emergency department opioid prescribing on health outcomes - (https://www.cmaj.ca/content/197/5/E122)

Source-Eurekalert