A new study published in the Canadian Medical Association Journal found that opioid prescriptions given in emergency departments (EDs) are linked to small increases in future opioid use and hospital visits. However, they do not appear to raise the risk of overdose or death.
Study Overview
Researchers examined opioid prescriptions from all emergency departments in Alberta between 2010 and 2020. The study analyzed data from more than 13 million ED visits, finding that 5.3% of patients (689,074 people) filled an opioid prescription.
The key findings were:
- Patients prescribed opioids were more likely to be hospitalized later (16.4% vs. 15.1% for those not prescribed opioids).
- They were also more likely to receive additional opioid prescriptions in the following year (4.5% vs. 3.3%).
- There was no increase in overdose or death risk among those prescribed opioids in the ED.
Balancing Pain Management and Risks
Emergency doctors often face challenges when prescribing opioids. While they must manage severe pain, they are also under pressure to limit opioid use due to concerns about addiction and misuse.
“Emergency physicians must treat pain and help opioid-tolerant patients who no longer have access to opioids, but there is little research to guide them,” said Dr. Grant Innes, professor of emergency medicine at the University of Calgary.
The study suggests that while single opioid prescriptions are not without risk, they are generally low-risk and unlikely to outweigh the benefits for patients in severe pain. However, some patients may be at higher risk of harm, including:
- Opioid-naive patients (those who have never used opioids before).
- Older adults who may be more vulnerable to side effects.
- Patients with multiple health conditions that complicate treatment.
- Frequent emergency department users, who may have underlying health or pain management issues.
Call for Better Guidance and Research
The authors urge doctors to consider individual patient risks when prescribing opioids and to be cautious with high-risk groups. They also highlight the need for further research to:
- Compare the risks of different opioid medications.
- Identify health conditions where opioids may be more or less appropriate.
Dr. Donna Reynolds, a family physician and acting co-chair of the Canadian Task Force on Preventive Health Care, noted in a related commentary that more research is urgently needed. She emphasized that better guidance will help doctors find the best way to treat acute pain while minimizing potential harm from opioid prescriptions.
Conclusion
This study reassures doctors that prescribing opioids for severe pain in the ED carries minimal risk of overdose or death. However, it also underscores the importance of careful prescribing, particularly for high-risk patients. As new research emerges, doctors will have better tools to balance effective pain relief with long-term safety.
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The research findings can be found in Canadian Medical Association Journal.
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