Prescription opioid misuse among ED patients discharged with opioids

• Published in: The American journal of emergency medicine 2014-06, Vol.32 (6), p.580-585
• Main Authors: Beaudoin, Francesca L., MD, MS, Straube, Steven, BS, Lopez, Jason, BS, Mello, Michael J., MD, MPH, Baird, Janette, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Drug abuse; Drug overdose; Emergency; Emergency medical care; Emergency Service, Hospital - statistics & numerical data; Family medical history; Fatalities; Female; Humans; Internet; Male; Middle Aged; Nonsteroidal anti-inflammatory drugs; Observational studies; Opioid-Related Disorders - epidemiology; Pain management; Patient Discharge - statistics & numerical data; Patients; Prescription Drug Misuse - statistics & numerical data; Prescription drugs; Prospective Studies; Risk Factors; Young Adult
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.02.030

Abstract Study Objectives The purposes of this study were to determine the prevalence of prescription opioid misuse in a cohort of discharged emergency department (ED) patients who received prescription opioids and to examine factors predictive of misuse. Methods This prospective observational study enrolled a sample of ED patients aged 18 to 55 years who were discharged with a prescription opioid. Participants completed surveys at baseline in the ED, then 3 and 30 days later. Follow-up surveys contained questions about opioid use and misuse, including screening questions from the National Epidemiologic Survey on Alcohol and Related Conditions. Patients were categorized as misusers if they (1) self-escalated their dose, (2) obtained additional prescription opioids without a prescription, or (3) used for a reason besides pain. Results Of the 85 patients who completed follow-ups, 36 (42%) reported misuse at either 3 or 30 days. There was no difference in demographic variables, pain scores, analgesic treatment, or discharge diagnoses between misusers and nonmisusers. Self-escalation of dose was the most common category of misuse (33/36; 92%). Taking prescription opioids without a doctor's prescription was reported by 39% (14/36), and taking pain medications for a reason other than pain was reported by 36% (13/36). The presence of disability, chronic pain, preexisting prescription opioid use, oxycodone use, and past 12-month risk of substance abuse were associated with misuse. Conclusions Prescription opioid misuse was prevalent among this cohort of ED patients. A heterogeneous mixture of behaviors was captured. Future research should focus on the etiologies of misuse with directed screening and interventions to decrease misuse.