title: Association of emergency department opioid initiation with recurrent opioid use.
abstract: OBJECTIVE
  Acute pain complaints are commonly treated in the emergency department (ED). Short courses of opioids are presumed to be safe for acute pain; however, the risk of recurrent opioid use after receipt of an ED opioid prescription is unknown. We describe the risk of recurrent opioid use in patients receiving an opioid prescription from the ED for an acute painful condition.
  
  
  METHODS
  This is a retrospective cohort study of all patients discharged from an urban academic ED with an acute painful condition during a 5-month period. Clinical information was linked to data from Colorado's prescription drug monitoring program. We compared opioid-naive patients (no opioid prescription during the year before the visit) who filled an opioid prescription or received a prescription but did not fill it to those who did not receive a prescription. The primary outcome was the rate of recurrent opioid use, defined as filling an opioid prescription within 60 days before or after the first anniversary of the ED visit.
  
  
  RESULTS
  Four thousand eight hundred one patients were treated for an acute painful condition; of these, 52% were opioid naive and 48% received an opioid prescription. Among all opioid-naive patients, 775 (31%) received and filled an opioid prescription, and 299 (12%) went on to recurrent use. For opioid-naive patients who filled a prescription compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 1.8 (95% confidence interval 1.3 to 2.3). For opioid-naive patients who received a prescription but did not fill it compared with those who did not receive a prescription, the adjusted odds ratio for recurrent use was 0.8 (95% confidence interval 0.5 to 1.3).
  
  
  CONCLUSIONS
  Opioid-naive ED patients prescribed opioids for acute pain are at increased risk for additional opioid use at 1 year.
authors.affiliation: Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO. Electronic address: jason.hoppe@ucdenver.edu.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Hoppe
authors.affiliation: Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Denver Health Residency in Emergency Medicine, Denver, CO.
authors.forename: Howard
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO; Rocky Mountain Poison and Drug Center, Denver, CO.
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D003120:Colorado; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000209:etiology*; D010146:Pain / Q000188:drug therapy*; D055553:Prescription Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs