Quantity of Opioids for Acute Pain and Limit Unused Medication (OPUM study)
Introduction
Prescription opioid overdoses have quadrupled in the last 15 years, and are now the leading cause of accidental death, surpassing motor vehicle accidents. The drastic rise in opioid prescription rates in Canada and the US could be the driving force behind this higher mortality. It was shown that 71% of opioid misusers (i.e., intentional users for nonmedical purposes) received their drugs through the diversion of unused prescribed opioids (transfer of opioids to someone other than the holder of the initial prescription). Emergency department (ED) physicians are among the top opioid prescribers, and there are currently no prospective studies on how many opioid pills should be prescribed to patients discharged from the ED with common pain conditions in order to limit unused pills. Preliminary results from our group revealed that two-thirds of the total prescribed opioids were not consumed and remained available for misuse.
Objectives
The ultimate goal of this research program is to decrease opioid misuse by lowering the quantity of unused medications. The primary objective of this project is to determine the quantity of opioids consumed during the acute pain phase (2 weeks) by ED-discharged patients treated for an acute pain condition The secondary objectives are to inventory unused opioid pills after ED visits, use of co-analgesics, pain intensity, and health services revisits during the 2-week follow-up.
Methods
We propose a pragmatic multicentre prospective observational cohort study in 2,456 consecutive ED patients recruited from 6 Canadian hospitals. We will include patients aged ≥18 years, treated for an acute pain condition present for less than 2 weeks (usual acute pain definition), and discharged from the ED with an opioid prescription. Pain at triage and at ED discharged, diagnosis, and complete pain medication prescription will be initially listed. Patients will complete a 14-day electronic diary using the REDCap web-based system to document their daily pain medication consumption, pain intensity, new opioid prescriptions, and health services revisits. To validate the patient self-report opioid consumption, we will use smart pill bottles that record the time and date of each opening in a randomized subset of patients. As mitigation strategies (validated in our pilot study), non-responders to the diary will be contacted by phone at 2 weeks to answered questions summing diary information’s, and paper versions will be available for patients without Internet access.
Impact
Our results will determine the quantity of opioids to prescribe during the acute pain phase (2 weeks) to ED-discharged patients treated for acute pain conditions. Our multidisciplinary team members from relevant provincial and national stakeholders and patient associations, our strong evidence, and our extensive knowledge transfer strategy have the potential to impact Canadian physicians’ opioid prescription practices. Consequently, fewer unused prescription opioids should lead to a substantial decrease in the currently high rate of opioid misuse in Canada.