title: Prescription opioid misuse among ED patients discharged with opioids.
abstract: OBJECTIVE
  The purposes of this study were to determine the prevalence of prescription opioid misuse in a cohort of discharged emergency department (ED) patients who received prescription opioids and to examine factors predictive of misuse.
  
  
  METHODS
  This prospective observational study enrolled a sample of ED patients aged 18 to 55 years who were discharged with a prescription opioid. Participants completed surveys at baseline in the ED, then 3 and 30 days later. Follow-up surveys contained questions about opioid use and misuse, including screening questions from the National Epidemiologic Survey on Alcohol and Related Conditions. Patients were categorized as misusers if they (1) self-escalated their dose, (2) obtained additional prescription opioids without a prescription, or (3) used for a reason besides pain.
  
  
  RESULTS
  Of the 85 patients who completed follow-ups, 36 (42%) reported misuse at either 3 or 30 days. There was no difference in demographic variables, pain scores, analgesic treatment, or discharge diagnoses between misusers and nonmisusers. Self-escalation of dose was the most common category of misuse (33/36; 92%). Taking prescription opioids without a doctor's prescription was reported by 39% (14/36), and taking pain medications for a reason other than pain was reported by 36% (13/36). The presence of disability, chronic pain, preexisting prescription opioid use, oxycodone use, and past 12-month risk of substance abuse were associated with misuse.
  
  
  CONCLUSIONS
  Prescription opioid misuse was prevalent among this cohort of ED patients. A heterogeneous mixture of behaviors was captured. Future research should focus on the etiologies of misuse with directed screening and interventions to decrease misuse.
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA. Electronic address: flb@brown.edu.
authors.forename: Francesca L
authors.initials: FL
authors.lastname: Beaudoin
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Straube
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Lopez
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mello
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, The Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Janette
authors.initials: J
authors.lastname: Baird
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult