A new Canadian Medical Association Journal (CMAJ) study found slight but significant increases in opioid consumption and hospital admissions after ED opioid prescriptions. The study, which examined over 13 million Alberta emergency department visits from 2010 to 2020, found that opioid prescriptions increased hospital admissions and opioid prescriptions but not death or overdose.

After analysing 13 million ED visits, researchers found that 689,074 patients, or 5.3%, received an opioid prescription. Patients who received opioids differed dramatically from those who did not. Opioids increased hospital admissions by 16.4% compared to 15.1% for non-opioids. Opioid-treated patients received 4.5% more opioid prescriptions in a year than non-opioid patients (3.3%). Despite these inequalities, opioid-related emergency visits, fatality rates, and new opioid agonist therapy use were similar.

"Emergency physicians face growing pressure to curtail opioid prescribing but must manage severe pain and treat opioid-tolerant patients who can no longer access opioids from their physicians," said University of Calgary emergency medicine professor Grant Innes. "There is little research to guide them." 

Given the elevated risks to particular patient populations, pain treatment must be more complicated. Opioid-naive people, elderly adults, patients with multiple health concerns, and frequent emergency room users are especially vulnerable to opioid side effects.

Due to a lack of tolerance, first-time opioid users are more prone to becoming reliant and having side effects. Older people are more sensitive since physiological changes might affect medication metabolism and cause complications. Complex prescription regimens for individuals with many health concerns may interact with opioids unexpectedly, increasing the likelihood of adverse effects.

Another high-risk group includes frequent ED visitors with severe pain. Addiction can result from opiate usage, especially if pain is not properly managed. Based on these data, the researchers recommend tailoring opioid prescriptions to patients' risk factors. "Physicians should understand the concept of patient-specific incremental risks when prescribing opioids for acute pain and prescribe cautiously within high-risk groups," the report concludes.

This personalised approach ensures patients receive adequate pain treatment while minimising side effects. Each patient's health profile and history can help doctors make better opioid use decisions, improving patient safety and outcomes.

The study shows that acute pain treatment prescribing recommendations are lacking. Dr. Donna Reynolds, acting co-chair of the Canadian Task Force on Preventive Health Care, supports this concern with her studies. She and her coauthors believe prescribers need more targeted research to balance pain therapy with side effects.

“Research and guidance in this area is long overdue,” adds Dr. Reynolds. "Only filling this research gap will allow acute pain prescribers and their patients to consider how to best ameliorate pain while minimising potential harms related to opioid prescription."

The medical and research community struggles to define "opioid naive" precisely. Researchers and healthcare providers disagree on how to define an opioid-naive patient, causing this ambiguity. Some recommend applying the phrase to persons who have never taken opioids, highlighting a strict definition that excludes past usage. Some argue that people who have not used opioids in 6–12 months should also be considered opioid-naive, as non-use may reduce some of the risks. Opioid-naive people have never used illicit opioids or narcotics, according to one view. This distinction between recreational and medical use is crucial. Lack of agreement hinders screening and preventive tool development and deployment. Without a worldwide definition, identifying and reducing opioid misuse risks, especially among first-time users, is difficult. This challenge highlights the need for more research and collaboration to establish clear guidelines for clinical and public health best practices.

Healthcare organisations like the Canadian Task Force on Preventive Health Care (CTFPHC) and the USPSTF are developing guidelines to prevent opioid-related harms for opioid-naive people due to the opioid crisis. These measures are crucial to addressing opioid addiction and misuse. The lack of verified research, which is essential for developing evidence-based procedures, hinders the creation of these standards.

Several opioid-related solutions have been proposed. Risk-stratification techniques assess patients' opioid dependence risk. These methods can help doctors identify patients in danger of becoming addicted, enabling more focused and preventive measures.

Another intriguing method is opioid contracts. These contracts provide patients with clear guidelines for opioid usage and disposal. By teaching patients how to use opioids appropriately, opioid contracts can prevent misuse and dependence.

Short-term prescriptions with partitioned doses and expiration dates are being researched to reduce opioid harms. Doctors can reduce chronic opioid use by limiting opioid prescription duration and quantity. This method reduces long-term dependency while treating pain adequately.

These therapies may be beneficial, but the study stresses the need for long-term research. It is vital to determine how well these treatments prevent chronic opioid use and its effects. Long-term research will prove the safety and efficacy of these medicines for patients prior to broad use.

A more nuanced and focused opioid prescribing approach is needed due to the opioid crisis. According to the study, governments and healthcare providers should take steps to improve pain treatment and reduce opioid risks.

One approach is to tailor opiate prescriptions to painful situations. This approach recognises that pain is variable and that different diseases require different treatments. By personalising drugs, doctors can prevent dependency and abuse.

We need risk-based opioid prescribing guidelines in addition to personalising prescriptions. These guidelines can help doctors decide how to take opioids based on pain severity, medical history, and addiction risk. Clinicians can better manage opioid risks and ensure they are used as needed by setting standards.

Patient education on opioid hazards is another essential part of a comprehensive plan. Addiction and overdose dangers of opiate use may be unknown to many patients. Healthcare practitioners can empower patients to choose pain treatments by providing clear and complete education. To prevent opioid abuse and diversion, this education should emphasise opioid dangers and correct handling and storage.

The CMAJ study stresses the challenging balance of immediate pain relief and opioid safety. Opioid prescriptions in emergency rooms pose serious risks, especially for high-risk patients. Clear guidelines, research, and targeted therapies are needed.

Dr. Reynolds and colleagues say, "Only by filling this research gap can we guide acute pain prescribers and their patients to make informed decisions while minimising opioid-related harms."