• Nguemeni TiakoMax JordanMJ0000-0002-5468-8926Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.Harvard Medical School, Boston, Massachusetts, USA.Center for Emergency Care Policy and Research, Department of Emergency Medicin, Frances Shofer, Abby Dolan, Erica B Goldberg, Karin V Rhodes, Erik P Hess, Venkatesh R Bellamkonda, Jeanmarie Perrone, Carolyn C Cannuscio, Lance Becker, Melissa A Rodgers, Michael M Zyla, Jeffrey J Bell, Sharon McCollum, Eden Engel-Rebitzer, Marilyn M Schapira, and Zachary F Meisel.
• Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
• Acad Emerg Med. 2023 Aug 1; 30 (8): 851858851-858.

BackgroundTo determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90 days after an emergency department (ED) visit for acute back or kidney stone pain.MethodsA total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative-enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race.ResultsComplete follow-up data were available for 851 participants; 23.3% (n = 198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, p < 0.001). Fifty-six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4-0.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05-5.87, p < 0.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04-0.08, p < 0.001 vs. 0.10, 95% CI 0.08-0.11, p < 0.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95).ConclusionsAmong Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing-which have been previously described within the context of this trial-may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort.© 2023 Society for Academic Emergency Medicine.

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