Association of acute opioid-induced euphoria and analgesia with subsequent opioid prescriptions in an emergency department-based prospective cohort study.

Objective: Emergency physicians have become hesitant to treat patients with opioids because of downstream sequelae related to opioid use disorder. We enrolled a prospective cohort to determine whether the experience of a patient receiving an intravenous (IV) opioid was associated with multiple opioid prescriptions. Specifically, we tested whether greater improvements in pain and a larger euphoric response could predict which previously opioid-naive patients exposed to IV opioids would fill at least two opioid prescriptions in the subsequent 6 months. Methods: We recorded pain scores (range, 0-10) before and 15 minutes after opioid-naive emergency department patients were given IV opioids to manage severe pain. We also determined opioid-induced euphoria (range, 0-10 points) by querying how good, how high, how much euphoria the opioid caused, and how likely the participant was to want the opioid again. Sixmonth outcomes were ascertained using the state prescription monitoring database. Results: Among 506 patients, 32 (6.3%) filled at least two prescriptions during the 6 months following the emergency department visit. TThere were no differences between those who filled ≥2 prescriptions and those who did not with regard to pain relief (P=0.54), how good the medication made participants feel (P=0.91), how high the medication made participants feel (P=0.97), how much euphoria the opioid caused (P=0.23), or how likely the participant was to want the medication again (P=0.37). Conclusion: Filling at least two opioid prescriptions was uncommon after initial exposure to therapeutic IV opioids and was unrelated to either analgesic efficacy or opioid-induced euphoria.