Place des opioïdes forts aux urgences

Abstract

Acute pain accounts for 70% of admissions to emergency departments, 45% of which are severe. In this context, strong opioids have a predominant place in the morphine management strategy. However, this position has been somewhat shaken up in recent years. The opioid crisis in the United States has raised awareness of the lack of safety of opioids in acute pain, and has given rise to a large body of research, the results of which are of benefit to us. One of the most interesting results for emergency departments is the assessment of the risk of misuse before such a prescription at discharge. Other studies have overturned the hierarchy, clearly demonstrating that non-opioids can be just as effective as opioids, thereby putting an end to the notion of analgesic levels. However, the prescription of strong opioids is still low in French emergency departments. This raises the question of the factors holding back these prescriptions, such as patients ‘refusal to take analgesics, opiophobia on the part of carers, carers’ reinterpretation of assessments and the need to monitor the administration of strong opioids in overcrowded emergency departments. This raises the question of the factors which slow down these prescriptions, such as the patient's refusal to take an analgesic, the opiophobia of carers, the carers' reinterpretation of assessments and the need to monitor the administration of strong opioids in saturated emergency departments. Finally, the methods of administering opioids have been extended with the demonstration of the efficacy of nebulised morphine and intranasal sufentanil. Finally, strong opioids are relevant to be prescribed as first-line treatment for severe pain of unknown aetiology, when NSAIDs are contraindicated, or when associated with certain well-identified pathologies. In 2nd-line treatment, they are useful for intense or severe pain after failure of non-opioids.