Association between fentanyl treatment for acute pain in the emergency department and opioid use two weeks after discharge.

Abstract

Analgesia with fentanyl can be associated with hyperalgesia (higher sensitivity to pain) and can contribute to escalating opioid use. Our objective was to assess the relationship between emergency department (ED) acute pain management with fentanyl compared to other opioids, and the quantity of opioids consumed two-week after discharge. We hypothesized that the quantity of opioids consumed would be higher for patients treated with fentanyl compared to those treated with other opioids. Patients were selected from two prospective cohorts assessing opioids consumed after ED discharge. Patients ≥18years treated with an opioid in the ED for an acute pain condition (≤2weeks) and discharged with an opioid prescription were included. Patients completed a 14-day paper or electronic diary of pain medication use. Quantity of 5mg morphine equivalent tablets consumed during a 14-day follow-up by patients treated with fentanyl compared to those treated with other opioids during their ED stay were analyzed using a multiple linear regression and propensity scores. We included 707 patients (mean age±SD: 50±15years, 47% women) in this study. During follow-up, patients treated with fentanyl (N=91) during their ED stay consumed a median (IQR) of 5.8 (14) 5mg morphine equivalent pills compared to 7.0 (14) for those treated with other opioids (p=0.05). Results were similar using propensity score sensitivity analysis. However, after adjusting for confounding variables, ED fentanyl treatment showed a trend, but not a statistically significant association with a decreased opioid consumption during the 14-day follow-up (B=-2.4; 95%CI=-5.3 to 0.4; p=0.09). Patients treated with fentanyl during ED stay did not consume more opioids after ED discharge, compared to those treated with other opioids. If fentanyl does cause more hyperalgesia compared to other opioids, it does not seem to have a significant impact on opioid consumption after ED discharge.