A study of academic emergency departments showed that fewer than 1% of opioid-naïve patients given IV opioids for acute pain developed persistent opioid use.
Patients utilizing the ED for severe acute pain are routinely treated with IV opioids. However, as rates of opioid use disorder (OUD) in the general population have risen, it is unclear if the use of IV opioids in the ED contributes to the development of OUD.
“We are not aware of compelling data to support denying parenteral opioids to opioid-naïve patients who are suffering from severe acute pain,” Eddie Irizarry, MD, and colleagues explained in The Journal of Emergency Medicine.
To help ED clinicians better understand long-term risks, the researchers investigated the incidence of persistent opioid use among patients exposed to IV opioids in the ED.
The prospective observational cohort study was conducted in two academic EDs at Montefiore in the Bronx, New York. The researchers reviewed the state opioid prescription database and followed up with opioid-naïve adults who experienced severe pain and received IV opioids in the ED. The investigators defined persistent opioid use as filling six or more prescriptions for opioids in the 6 months following the ED visit, or an average of one prescription per month.
Of 1,555 patients screened, 506 met the study criteria. The most frequently reported IV opioid administered in the ED was morphine (n=478, 94%), followed by hydromorphone (n=20, 4%). A total of 8 patients (2%) received both IV morphine and hydromorphone, and 63 patients (12%) received an opioid prescription for use after the ED visit.
Only one patient used opioids persistently during the subsequent 6 months.
“Fewer than 1% of opioid-naïve patients discharged from our EDs after receipt of an IV opioid transitioned to persistent opioid use within 6 months,” Dr. Irizarry and coauthors said. “These data suggest that the use of IV opioids for acute pain among opioid-naïve patients is extremely unlikely to result in persistent opioid use. However, it must be noted that most patients included in this study were treated with relatively modest doses of morphine.”
