Moderation – Not Prohibition – Is Key to Treating ER Patients With Opioids
/By Pat Anson, PNN Editor
Over the years many people living with pain have told us that they avoid going emergency rooms because they fear their pain will be ignored and that they’ll be treated as an addict if they ask for opioids.
“Going to the ER terrifies me and I am an RN,” one patient said. “I was recently there on 2 separate episodes for kidney stones. Over a three-day period they gave me absolutely nothing for pain!”
“I can't and won't return to an ER even if I am dying because I won't accept being treated like an addict ever again,” said a 60-year-old disabled woman.
“It took me 12 hours and a staged public fit to get any pain relief at my local ER when I went in with a pinched nerve,” another patient told us.
“Called suicide hotline and was told to go to ER,” said a woman suffering from a severe flare from rheumatoid arthritis. “Well, that was a waste. Told I was drug seeking and received a hefty bill to pile on top of all the others.”
A new study suggests that moderation – not prohibition -- is the key to treating pain in the ER with opioids. Researchers in Canada found that half of patients discharged from an emergency department needed only a handful of opioid tablets to control their pain.
“Patients are often prescribed too many opioid tablets and that means unused tablets are available for misuse,” Raoul Daoust, MD, a professor of Family and Emergency at University of Montreal, said in a press release. “On the other hand, since the opioid crisis, the tendency in the USA is to not prescribe opioids at all, leaving some patient in agonising pain.
“With this research I wanted to provide a tailored approach to prescribing opioids so that patients have enough to manage their pain but almost no unused tablets available for misuse.”
Daoust and his colleagues surveyed 2,240 adult patients who were treated for acute pain at one of six hospital emergency departments in Canada. All were discharged with an opioid prescription and were asked to complete a pain diary for two weeks.
Their findings, presented over the weekend at the European Emergency Medicine Congress in Spain, showed five or fewer morphine tablets (5mg) were adequate for about half the patients. The rest needed more tablets, depending on their condition. For example, patients suffering from renal colic or abdominal pain needed eight tablets, while a patient with broken bones needed 24 tablets.
Daoust says emergency room physicians need to recognize that morphine can be “very beneficial” for patients. The key is to individualize treatment and prescribe the right amount to minimize the risk of addiction.
“Our findings make it possible to adapt the quantity of opioids we prescribe according to patient need. We could ask the pharmacist to also provide opioids in small portions, such as five tablets initially, because for half of patients that would be enough to last them for two weeks,” said Daoust.
The researchers plan to apply their findings in a clinical setting to evaluate whether they can reduce the long-term use and misuse of opioids.
“This study shows how opioid prescriptions could be adapted to specific acute pain conditions, and how they could be dispensed in relatively small numbers at the pharmacy to lower the chance of misuse. This research could provide a safer way to prescribe opioids that could be applied in emergency departments anywhere in the world,” said Youri Yordanov, MD, an emergency physician at Saint-Antoine Hospital in Paris, who was not involved in the research.
A large 2017 study found that the risk of long-term opioid use is lower for ER patients than it is for patients treated in other medical settings. Researchers found that only 1.1% percent of ER patients taking opioids for the first time progressed to long term use. That compares to 2% of patients in non-emergency settings.
