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Original article
Predicting opioid use disorder in patients with chronic pain who present to the emergency department
  1. Robert Andrew Gardner1,
  2. Kori L Brewer1,2,
  3. Dennis B Langston2
  1. 1 Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
  2. 2 Emergency Department, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
  1. Correspondence to Dr Kori L Brewer, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; brewerk{at}ecu.edu

Abstract

Background Emergency department (ED) patients with chronic pain challenge providers to make quick and accurate assessments without an in-depth pain management consultation. Emergency physicians need reliable means to determine which patients may receive opioid therapy without exacerbating opioid use disorder (OUD).

Methods Eighty-nine ED patients with a chief complaint of chronic pain were enrolled. Researchers administered questionnaires and reviewed medical and state prescription monitoring database information. Participants were classified as either OUD or non-OUD. Statistical analysis included a bivariate analysis comparing differences between groups and multivariate logistic regression evaluating ORs.

Results The 45 participants categorised as OUD had a higher proportion of documented or reported psychiatric diagnoses (p=0.049), preference of opioid treatment (p=0.005), current oxycodone prescription (p=0.043), borrowed pain medicine (p=0.004) and non-authorised dose increase (p<0.001). The state prescription monitoring database revealed the OUD group to have an increased number of opioid prescriptions (p=0.005) and pills (p=0.010). Participants who borrowed pain medicine and engaged in non-authorised dose increase were 5.2 (p=0.025, 95% CI 1.24 to 21.9) and 6.1 times (p=0.001, 95% CI 1.55 to 24.1) more likely to have OUD, respectively.

Limitations Major limitations of our study include a small sample size, self-reported measures and convenience sample which may introduce selection bias.

Conclusion Patients with chronic pain with OUD have distinguishable characteristics. Emergency physicians should consider such evidence-based variables prior to opioid therapy to ameliorate the opioid crisis and limit implicit bias.

  • chronic pain
  • opioid use disorder
  • emergency department

http://dx.doi.org/10.1136/injuryprev-2018-042723

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    Footnotes

    • Contributors RAG revised research protocol, wrote the statistical analysis plan, collected and managed the data, analysed the data, drafted and revised the manuscript. KLB revised research proposal and protocol, designed data collection tools and surveys, monitored data collection and analysis, drafted and revised the manuscript. She is the guarantor. DBL developed idea for project, wrote research proposal and protocol, developed data collection tools and surveys, collected data and revised the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval University and Medical Center Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Individual participant data that underlie the results reported in this article, after de-identification, will be available to researchers who provide a methodologically sound, IRB-approved proposal. There must be an analysis to achieve aims in the approved proposal. Other documents available on request include study protocol, statistical analysis and analytic code. The data will be available 3 months after publication and ending 5 years after article publication. Proposals should be directed to the corresponding author. To gain access, data requestors will need to sign a data access agreement.