ArticleAnnals of emergency medicine2025
A Prospective Cohort Study to Determine Which Opioid-Naïve Emergency Department Patients Are at Risk of Persistent Opioid Use.
Article in Annals of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
STUDY
objectiveIt is unclear which opioid-naïve emergency department (ED) patients prescribed an opioid progress to opioid use disorder. We tested the hypothesis that opioid-induced euphoria and persistent pain 2 weeks after an ED visit would be associated with persistent prescribed opioid use among opioid-naïve ED patients who presented to the ED with pain and were discharged with an opioid prescription.
methodsThis was a prospective cohort study. We enrolled patients during an ED visit and followed them by telephone 48 hours, 2 weeks, and 6 months later. We also reviewed the state prescription monitoring database at 6 months. Persistent opioid use was defined as ≥1 opioid prescription/month after ED discharge. At 48 hours, participants were asked: How much euphoria, joy, or happiness did the opioid medication give you? and how much would you like to use the medication again? Each of these was assessed on a 0 to 10 scale. Pain was measured with a 4-item ordinal scale: severe, moderate, mild, or none.
resultsA total of 699 patients were eligible for participation and enrolled. Of these, 17/699 (2%) developed new-onset persistent opioid use. Median feeling euphoria, joy, or happiness was 0 (interquartile range [IQR]: 0, 0); median like to use again was 6 (IQR: 0, 10). A total of 296/256 (45%) reported moderate or severe pain in the affected area at 2 weeks. Neither euphoria/joy/happiness (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.61 to 1.15) nor take again (OR 1.06, 95% CI 0.92 to 1.21) was associated with persistent opioid use. Moderate or severe pain was associated with persistent opioid use (OR 5.15, 95% CI 1.43 to 18.50).
conclusionPersistence of pain 2 weeks later but not opioid-induced euphoria is associated with progression to persistent prescribed opioid use. If validated, these data would allow an integrated health care system to identify patients at risk of progression.
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