Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Québec, Canada.
Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, Québec, Canada.
Acad Emerg Med. 2019 Aug;26(8):847-855. doi: 10.1111/acem.13628. Epub 2019 Jul 18.
Studies evaluating long-term prescription opioid use are retrospective and based on filled opioid prescriptions from governmental databases. These studies cannot evaluate if opioids were really consumed and are unable to differentiate if they were used for a new pain or chronic pain or were misused. The aim of this study was to assess opioid use rate and reasons for consuming 3 months after being discharged from the emergency department (ED) with an opioid prescription.
This is a prospective cohort study conducted in the ED of a tertiary care urban center with a convenience sample of discharged patients ≥ 18 years who consulted for an acute pain condition (≤2 weeks). Three months post-ED visit, participants were interviewed by phone on their past 2-week opioid consumption and their reasons for consuming: a) for pain related to the initial ED visit, b) for a new unrelated pain, or c) for another reason.
Of the 524 participants questioned at 3 months (mean ± SD age = 51 ± 16 years, 47% women), 47 patients (9%, 95% confidence interval [CI] = 7%-12%) reported consuming opioids in the previous 2 weeks. Among those, 34 (72%) reported using opioids for their initial pain, nine (19%) for a new unrelated pain and four (9%) for another reason (0.8%, 95% CI = 0.3%-2.0%, of the whole cohort). Patients who used opioids during the 2 weeks after the ED visit were 3.8 (95% CI = 1.2-12.7) times more likely to consume opioids at 3 months.
Opioid use at the 3-month follow-up in ED patients discharged with an opioid prescription for an acute pain condition is not necessarily associated with opioid misuse; 91% of those patients consumed opioids to treat pain. Of the whole cohort, less than 1% reported using opioids for reasons other than pain. The rate of long-term opioid use reported by prescription-filling database studies should not be viewed as a proxy for incidence of opioid misuse.
评估长期处方类阿片类药物使用情况的研究是回顾性的，并且基于政府数据库中的已用阿片类药物处方。这些研究无法评估阿片类药物是否真的被消耗，也无法区分它们是用于新的疼痛还是慢性疼痛，还是被滥用。本研究的目的是评估从急诊科（ED）出院后 3 个月内的阿片类药物使用率和使用原因，这些患者因急性疼痛（≤2 周）就诊时开具了阿片类药物处方。
这是一项在三级城市中心急诊科进行的前瞻性队列研究，对方便抽样的≥18 岁出院患者进行调查，这些患者因急性疼痛（≤2 周）就诊。在 ED 就诊后 3 个月，通过电话对患者进行过去 2 周的阿片类药物使用情况及其使用原因进行访谈：a）与初始 ED 就诊相关的疼痛，b）新的无关疼痛，或 c）其他原因。
在 524 名接受 3 个月调查的患者中（平均年龄±标准差为 51±16 岁，47%为女性），47 名患者（9%，95%置信区间[CI]为 7%-12%）报告在过去 2 周内使用过阿片类药物。其中，34 名（72%）报告为治疗初始疼痛而使用阿片类药物，9 名（19%）为治疗新的无关疼痛，4 名（9%）为其他原因（整个队列的 0.8%，95%CI 为 0.3%-2.0%）。在 ED 就诊后 2 周内使用阿片类药物的患者，在 3 个月时更有可能使用阿片类药物，其可能性是未使用阿片类药物的患者的 3.8 倍（95%CI 为 1.2-12.7）。
ED 患者因急性疼痛开具阿片类药物处方后，在 3 个月随访时使用阿片类药物不一定与阿片类药物滥用有关；91%的患者使用阿片类药物来治疗疼痛。在整个队列中，不到 1%的患者报告因疼痛以外的其他原因使用阿片类药物。基于处方开具数据库研究报告的长期阿片类药物使用率不应被视为阿片类药物滥用发生率的替代指标。
