A study published in the Canadian Medical Association Journal (CMAJ.ca) indicates that opioids prescribed in hospital emergency departments were associated with only small increases in follow-up opioid prescriptions, and were not associated with patient overdoses or deaths.
The study was based on data from Alberta hospital emergency room visits over a 10-year period from January 2010 to June of 2020. After more than 13,000,000 eligible visits, more than 689,000 patients (5.3 per cent) filled an opioid prescription.
The mean age was 43.9 years, and 49.8 per cent of patients were female.
Most of those who filled prescriptions were described as high-acuity patients with traumatic, gastrointestinal–genitourinary or musculoskeletal complaints.
The study said its method was to use data to sample all Alberta emergency department visits. This included patients who filled an opioid prescription within 72 hours of their emergency room visit.
Data was collected on all individuals over the age of 12 over the 10 years. Patients with obvious opioid use disorder, or patients with previously prolonged opioid use in the prior year, were excluded.
The study also excluded any patient who had palliative care, or patients with a cancer diagnosis or taking chemotherapy.
The study also mentioned that opioid prescriptions are known as a factor in overdose-related deaths, and this is one reason why there has been a substantial reduction in the number of prescriptions.
"Despite these reductions, mortality has increased, with more than 500,000 opioid-related deaths in North America since 2016,” said the study.
“In Alberta, Canada, the proportion of people who filled an opioid prescription dropped 35 per cent between 2016 and 2021, but opioid-related deaths tripled, from 554 to 1,510 per year, largely because of potent opioids in the illegal market," said the study.
The study's interpretation was that emergency department opioid prescriptions were associated with small increases in subsequent opioid prescription use and hospital admission, particularly in older and opioid-naive patients and males.
They (ER prescriptions) were not associated with overdoses, new opioid agonist therapy, or mortality. Physicians should understand patient-specific incremental risks when prescribing opioids for acute pain, said the study.
"These results have practice implications," the authors wrote. "They provide precise population and subgroup risk estimates. They confirm that single opioid prescriptions are not risk-free but that the likelihood of harm is low and unlikely to outweigh the benefit of treating severe pain.
“Our findings also show that patient characteristics influence risk and that the outcomes were associated with opioid-naive status, older age, frequent emergency department use, and high illness burden."
The study was authored by Jake Hayward, Rhonda J. Rosychuk, Andrew D. McRae, Aynharan Sinnarajah, Kathryn Dong, Robert Tanguay, Lori Montgomery, Andrew Huang and Grant Innes; representing physicians and researchers at University of Alberta Department of Emergency Medicine, and Department of Pediatrics; University of Calgary Department of Medicine, and Department of Family Medicine; and Queen's University Department of Emergency Medicine; among others.
The full text version of the study can be found online here.