Raoul Daoust, Jean Paquet, Marcel Émond, Massimiliano Iseppon, David Williamson, Justin W Yan, Jeffrey J Perry, Vérilibe Huard, Gilles Lavigne, Jacques Lee, Justine Lessard, Eddy Lang, Alexis Cournoyer
Background: Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids.
Methods: In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period.
Results: We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets).
Interpretation: Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse.
{"title":"Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study.","authors":"Raoul Daoust, Jean Paquet, Marcel Émond, Massimiliano Iseppon, David Williamson, Justin W Yan, Jeffrey J Perry, Vérilibe Huard, Gilles Lavigne, Jacques Lee, Justine Lessard, Eddy Lang, Alexis Cournoyer","doi":"10.1503/cmaj.231640","DOIUrl":"10.1503/cmaj.231640","url":null,"abstract":"<p><strong>Background: </strong>Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids.</p><p><strong>Methods: </strong>In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period.</p><p><strong>Results: </strong>We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (<i>p</i> < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets).</p><p><strong>Interpretation: </strong>Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, no. NCT03953534.</p>","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infections liées aux dispositifs cardiaques électroniques implantables.","authors":"Maxime J Billick, Orly Bogler, Wayne L Gold","doi":"10.1503/cmaj.231121-f","DOIUrl":"10.1503/cmaj.231121-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mélanome dans un nævus mélanocytaire congénital.","authors":"Amy Zeglinski-Spinney, Mark G Kirchhof","doi":"10.1503/cmaj.240037-f","DOIUrl":"10.1503/cmaj.240037-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Enregistrement des essais cliniques et production de rapports sur les résultats: un appel à la transparence, à la coordination et à une application rigoureuse des règles.","authors":"Matthew Herder, Srinivas Murthy","doi":"10.1503/cmaj.231595-f","DOIUrl":"10.1503/cmaj.231595-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acetaminophen as a cause of \"non-acetaminophen-related acute liver failure\".","authors":"Stephen A Hoption Cann","doi":"10.1503/cmaj.150837-l","DOIUrl":"10.1503/cmaj.150837-l","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to \"Addressing the risks of antidepressants among people with alcohol use disorders\".","authors":"","doi":"10.1503/cmaj.240910","DOIUrl":"10.1503/cmaj.240910","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Signs of death.","authors":"Heidi Marx","doi":"10.1503/cmaj.231704","DOIUrl":"10.1503/cmaj.231704","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A call to stop extractive health research on South Asian diaspora communities in Canada.","authors":"Gina Agarwal, Ananya Tina Banerjee, Jasdeep Brar","doi":"10.1503/cmaj.231189","DOIUrl":"10.1503/cmaj.231189","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11268149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gender self-determination as a medical right.","authors":"Florence Ashley","doi":"10.1503/cmaj.230935","DOIUrl":"10.1503/cmaj.230935","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heather Murray, Christopher Gillies, Armand Aalamian
{"title":"L’incivilité des médecins dans le milieu de la santé.","authors":"Heather Murray, Christopher Gillies, Armand Aalamian","doi":"10.1503/cmaj.231377-f","DOIUrl":"10.1503/cmaj.231377-f","url":null,"abstract":"","PeriodicalId":9609,"journal":{"name":"Canadian Medical Association journal","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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