Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO.
Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Denver Health Residency in Emergency Medicine, Denver, CO.
Ann Emerg Med. 2015 May;65(5):493-499.e4. doi: 10.1016/j.annemergmed.2014.11.015. Epub 2014 Dec 18.
Acute pain complaints are commonly treated in the emergency department (ED). Short courses of opioids are presumed to be safe for acute pain; however, the risk of recurrent opioid use after receipt of an ED opioid prescription is unknown. We describe the risk of recurrent opioid use in patients receiving an opioid prescription from the ED for an acute painful condition.
This is a retrospective cohort study of all patients discharged from an urban academic ED with an acute painful condition during a 5-month period. Clinical information was linked to data from Colorado's prescription drug monitoring program. We compared opioid-naive patients (no opioid prescription during the year before the visit) who filled an opioid prescription or received a prescription but did not fill it to those who did not receive a prescription. The primary outcome was the rate of recurrent opioid use, defined as filling an opioid prescription within 60 days before or after the first anniversary of the ED visit.
Four thousand eight hundred one patients were treated for an acute painful condition; of these, 52% were opioid naive and 48% received an opioid prescription. Among all opioid-naive patients, 775 (31%) received and filled an opioid prescription, and 299 (12%) went on to recurrent use. For opioid-naive patients who filled a prescription compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 1.8 (95% confidence interval 1.3 to 2.3). For opioid-naive patients who received a prescription but did not fill it compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 0.8 (95% confidence interval 0.5 to 1.3).
Opioid-naive ED patients prescribed opioids for acute pain are at increased risk for additional opioid use at 1 year.
急诊科（ED）常治疗急性疼痛。短期使用阿片类药物治疗急性疼痛被认为是安全的；然而，接受 ED 阿片类药物处方后反复使用阿片类药物的风险尚不清楚。我们描述了接受 ED 阿片类药物处方治疗急性疼痛的患者中反复使用阿片类药物的风险。
这是一项回顾性队列研究，研究对象为在 5 个月期间因急性疼痛状况从城市学术 ED 出院的所有患者。临床信息与科罗拉多州处方药物监测计划的数据相关联。我们将阿片类药物初治患者（就诊前 1 年内未开具阿片类药物处方）与开具阿片类药物处方或开具但未开具处方的患者进行比较。主要结局是反复使用阿片类药物的发生率，定义为在 ED 就诊后 1 年内 60 天内再次开具阿片类药物处方。
4801 例患者因急性疼痛状况接受治疗；其中 52%为阿片类药物初治患者，48%开具了阿片类药物处方。在所有阿片类药物初治患者中，775 例（31%）接受并开具了阿片类药物处方，299 例（12%）转为反复使用。与未开具处方的患者相比，开具处方且实际使用的阿片类药物初治患者，其反复使用的调整后比值比为 1.8（95%置信区间 1.3 至 2.3）。与未开具处方的患者相比，开具处方但未实际使用的阿片类药物初治患者，其反复使用的调整后比值比为 0.8（95%置信区间 0.5 至 1.3）。
因急性疼痛状况而开具阿片类药物处方的阿片类药物初治 ED 患者在 1 年内有更高的额外使用阿片类药物的风险。
