Association of Emergency Department Opioid Administration With Ongoing Opioid Use: A Retrospective Cohort Study of Patients With Back Pain

Abstract

Objectives: Opioids are commonly administered in the emergency department (ED) and prescribed for the treatment of back pain. It is important to understand the unintended consequences of this approach to inform treatment decisions and the consideration of alternative treatments. Recent evidence has shown that ED opioid prescriptions are associated with future opioid use. The objective of this study was to measure the association of opioid administration in the ED to patients treated for back pain with future opioid use. Methods: This is a retrospective study of opioid-na€ ıve adults discharged from the ED with a diagnosis of back pain. Patients were stratified by opioid therapy (none, ED administration only, prescription only, or ED administration + prescription). Relative risks of ongoing opioid use (filling >90-day supply in 180 days following ED visit as documented in the prescription drug monitoring program) were calculated for each opioid-therapy group and compared to the no-opioid group. Results: We identified 24,487 opioid na€ ıve back pain patients. The median age was 38 years, 55% were female, and 56% were non-Hispanic white. A total of 41% received no opioid, 10% were only administered an opioid in the ED, 18% only received a prescription, and 31% received an opioid in the ED + prescription. The adjusted relative risks of ongoing use compared to the no opioid group were as follows: ED only 1.9, prescription only 2.1, and ED + prescription 2.3. The increased risk persisted for other definitions of ongoing use and after adjustment for baseline pain scores. Conclusions: For opioid-na€ ıve patients with back pain, both administration of an opioid in the ED and opioid prescriptions are associated with a doubling of the risk of ongoing opioid use compared to patients not treated with opioids. This supports the consideration of minimizing exposure to opioids while treating back pain in the ED.

Association between clusters of back and joint pain with opioid use in middle-aged community-based women: a prospective cohort study

“…For example, a study from Canada, including participants with non-urgent low back pain over a six-year period, showed that one quarter of the participants were prescribed hydromorphone [49]. In another study, 51% of the opioid naïve back pain patients received opioids in the emergency department [50]. Our study extends the understanding beyond these studies by reporting opioid use in a community-based sample in relation to back pain and joint pain clusters over 12 years.…”

Prevalence, predictors and trends of opioid prescribing for lower back pain in United States emergency departments

“…Additionally, opioid use was not associated with decreased duration of disability or subsequent lower back surgery, suggesting limited effectiveness and further supporting guideline recommendations 11 . In an observational cohort study, 2% of opioid‐naïve patients who presented to the ED for back pain had ongoing use of opioids (when defined as prescriptions for >90‐day supply 180 days after discharge from the ED) 12 . The rate of ongoing use was doubled when defining ongoing use as patients who had ≥ four prescriptions for opioids within the first six months post‐discharge from the ED.…”

“…11 In an observational cohort study, 2% of opioid-naïve patients who presented to the ED for back pain had ongoing use of opioids (when defined as prescriptions for >90-day supply 180 days after discharge from the ED). 12 The rate of ongoing use was doubled when defining ongoing use as patients who had ≥ four prescriptions for opioids within the first six months post-discharge from the ED. Patients who were given an opioid in the ED and discharged with a prescription had over a two-fold increased risk for ongoing opioid use compared to those who presented for back pain who received no opioid.…”

Emergency department opioid discharge instructions: a multidisciplinary national Delphi study

“…One study that performed audio recordings of discharge instructions given to patients receiving opioid prescriptions found that only one encounter out of forty-seven addressed the addictive potential of opioids [13]. This is despite recent evidence showing a link between opioid prescriptions to opioidnaive patients in the ED and the risk of chronic use [4,5]. Our review of the literature and local/national ED opioid discharge instructions revealed wide variation in the concepts included in specific written instructions.…”

“…The majority of these deaths are linked to opioids [2,3]. Recent literature demonstrates that there is a relationship between emergency department (ED) opioid prescription and the risk of long-term use in previously opioid-naive patients [4,5]. Emergency physicians are among the top five prescribers of outpatient opioid medication [6,7].…”