Prescribed opioids in the ER? You may be getting too many pills, study suggests

What happens after Canadian patients are prescribed addictive opioids in the emergency department for short-term pain? The answer from a new study is being called an "eye opener." 

The issue matters because of the overdose crisis, which has killed more than 44,000 people in opioid-related deaths since 2016, according to Health Canada. In 2023, 22 people died each day on average, the latest figures show. 

While much of that harm comes from the illicit drug supply, including fentanyl, half the people with an opioid-use disorder say they were first exposed to the powerful painkillers through a legitimate prescription.

The study published Monday in the Canadian Medical Association Journal focuses on finding the sweet spot between minimizing unused opioid prescriptions from emergency departments — to drive down misuse — while still taking care of patients' acute pain.

Dr. Raoul Daoust of Montreal's Sacré-Coeur Hospital and his co-authors analyzed the results from 2,240 adults in Ontario and Quebec, half under age 51, who went to an emergency department for acute pain lasting less than two weeks. All participants were discharged with a prescription for opioids. 

The team found two-thirds of the medications prescribed were filled and not used. 

"I really hope that physicians are going to be more precise in the prescription," said Daoust, who is an emergency physician and clinician-scientist. 

Daoust and his team aim to provide clinicians with guidance on prescribing smaller portions of opioids tailored to the specific cause of acute pain.

"I think right now the easiest thing is to say 'I don't give any,'" Daoust said. "But you let somebody suffer at home," and if acute pain isn't taken care of adequately it can lead to chronic pain.

The researchers from Montreal, Quebec City, Toronto, London and Calgary asked participants if they filled their prescriptions, how many opioid pills they took (converted to 5 mg morphine per tablet for comparison purposes), and if they filled any new prescriptions, using 14-day diaries and follow-up phone interviews.

The amount of opioids taken varied greatly between the conditions, which included fractures, back pain, neck pain, abdominal pain and pain such as tendonitis as well as renal colic that occurs when a stone blocks the urinary tract.

Half of patients consumed fewer than five tablets. The most common reason they gave for stopping was that the pain got better.

Half of participants received a prescription of 16 tablets or more.

To relieve pain in most patients, the researchers found small quantities of opioids were taken, such as: