228 Unused Opioid Analgesics Prescribed From the Emergency Department

Abstract

Prescription opioid analgesics represent a cornerstone of acute pain management. However, patients treated with opioids are at risk for serious harms including tolerance, dependence, addiction, and overdose; these unintended negative effects impose a massive societal burden in the U.S. To date, little data exists to guide emergency providers on proper dosing of these medications. Our study aims to describe self-reported opioid use patterns of patients presenting to the emergency department with acute pain. This prospective cohort study employed a validated, cross-sectional survey of subjects identified using electronic medical records. Eligible participants included English-speaking patients aged 18-89 who received an opioid prescription from an ED in a large hospital network. Exclusion criteria included admission to the hospital; prior or current EMR diagnosis of opioid dependence, dementia, or intellectual disability; associated diagnosis of cancer, opioid withdrawal, or postoperative pain; or EMR record of a prior opioid prescription within the previous 30 days. The survey link was emailed to a continuous sample of subjects 3-4 weeks after discharge. Nonresponders after 1 week were surveyed via telephone. Descriptive statistics were used to describe survey results. Of 500 eligible subjects, there were 195 total respondents; 126 completed the questionnaire. Only 28% of subjects reported that they took all of the prescribed pills. Twenty percent stated that they did not take any pills, 33% took about one fourth, 7.2% took about half, and 12.4% took about three fourths of the pills. Among those who did not take any pills, 58% did not fill the prescription. Reasons for not taking any pills included: “pain was controlled without taking any pills” (68%), “concern about side effects” (16%), “concern about developing addiction or dependence” (10%), and “insurance issues” (5.3%). Among those who took some but not all prescribed pills, about half (51%) reported that they did not use all of the pills because their pain was adequately controlled, 24% were concerned about dependence or addiction, 16% stopped because side effects were too severe, and 6% did not feel that the pills helped their pain. Prescribed pill counts ranged from 3 to 30 (20-300 morphine equivalents); there was no association between number of pills/morphine equivalents and proportion of pills taken. Twenty-four percent reported that they had received an additional opioid prescription within the follow-up time frame (3-5 weeks after the ED visit). Less than one third of patients who receive prescriptions in the emergency department for acute pain use all of their prescribed pills. Many patients fill prescriptions for opioids but then do not use any pills. These data suggest that patients are often prescribed opioids unnecessarily for acute conditions or are prescribed more pills than they need. Excess prescriptions represent a possible source of pills for diversion or accidental overdose.