Opioid Rx in the ED Slightly Raises Risk for Future Opioid Use, Hospitalization
MONDAY, Feb. 10, 2025 -- Emergency department opioid prescriptions are associated with small increases in hospital admission and subsequent opioid prescription use, according to a study published online Feb. 10 in CMAJ, the journal of the Canadian Medical Association.
Jake Hayward, M.D., M.P.H., from the University of Alberta in Edmonton, Canada, and colleagues sampled all Alberta emergency department visits over 10 years, excluding patients with cancer, palliative care, or concurrent opioid use, to quantify adverse outcomes, incremental risk, and rates of prolonged opioid use among patients who received an opioid prescription. Treated patients filled an opioid prescription within 72 hours after the index visit; they were propensity score-matched to controls among untreated patients who did not fill an opioid prescription.
Overall, 689,074 (5.3 percent) of patients filled an opioid prescription after 13,028,575 eligible visits. The researchers found that most of the patients who filled an opioid prescription were high-acuity patients with traumatic, gastrointestinal-genitourinary, or musculoskeletal complaints. Patients who received opioids experienced more primary outcome events (opioid-related emergency visits [e.g., overdoses], new opioid agonist therapy, all-cause hospital admission, or death; 17.1 versus 15.7 percent), which was driven by all-cause mortality (16.4 versus 15.1 percent; number needed to harm, 53) and prolonged opioid use (4.5 versus 3.3 percent; number needed to harm, 59). Patients with documented mental health conditions or substance use had low incremental risk, while opioid-naive patients, older patients, and men had the highest incremental risk.
"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 write.
Several authors disclosed ties to industry.
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