A Prospective Cohort Study to Determine Which Opioid-Naïve Emergency Department Patients Are at Risk of Persistent Opioid Use

Study objective: It is unclear which opioid-naïve emergency department (ED) patients prescribed an opioid progress to opioid use disorder. We tested the hypothesis that opioid-induced euphoria and persistent pain 2 weeks after an ED visit would be associated with persistent prescribed opioid use among opioid-naïve ED patients who presented to the ED with pain and were discharged with an opioid prescription. Methods: This was a prospective cohort study. We enrolled patients during an ED visit and followed them by telephone 48 hours, 2 weeks, and 6 months later. We also reviewed the state prescription monitoring database at 6 months. Persistent opioid use was defined as ≥1 opioid prescription/month after ED discharge. At 48 hours, participants were asked: How much euphoria, joy, or happiness did the opioid medication give you? and how much would you like to use the medication again? Each of these was assessed on a 0 to 10 scale. Pain was measured with a 4-item ordinal scale: severe, moderate, mild, or none. Results: A total of 699 patients were eligible for participation and enrolled. Of these, 17/699 (2%) developed new-onset persistent opioid use. Median feeling euphoria, joy, or happiness was 0 (interquartile range [IQR]: 0, 0); median like to use again was 6 (IQR: 0, 10). A total of 296/256 (45%) reported moderate or severe pain in the affected area at 2 weeks. Neither euphoria/joy/happiness (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.61 to 1.15) nor take again (OR 1.06, 95% CI 0.92 to 1.21) was associated with persistent opioid use. Moderate or severe pain was associated with persistent opioid use (OR 5.15, 95% CI 1.43 to 18.50). Conclusion: Persistence of pain 2 weeks later but not opioid-induced euphoria is associated with progression to persistent prescribed opioid use. If validated, these data would allow an integrated health care system to identify patients at risk of progression.