RT Journal Article
SR Electronic
T1 Predicting opioid use disorder in patients with chronic pain who present to the emergency department
JF Injury Prevention
JO Inj Prev
FD BMJ Publishing Group Ltd
SP injuryprev-2018-042723
DO 10.1136/injuryprev-2018-042723
A1 Robert Andrew Gardner
A1 Kori L Brewer
A1 Dennis B Langston
YR 2018
UL http://injuryprevention.bmj.com/content/early/2018/04/06/injuryprev-2018-042723.abstract
AB 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.