• Raoul Daoust, Jean Paquet, Marcel Émond, Massimiliano Iseppon, David Williamson, Justin W Yan, Jeffrey J Perry, Vérilibe Huard, Gilles Lavigne, Jacques Lee, Justine Lessard, Eddy Lang, Alexis Cournoyer, and Quantity of Opioids for Acute Pain and Limit Unused Medication (OPUM) group on behalf of the Network of Canadian Emergency Researchers.
• Study Centre in Emergency Medicine (Daoust, Paquet, Huard, Lessard, Cournoyer), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Nord-de-l'Île de-Montréal, Sacré-Coeur Hospital; Département de médecine de famille et médecine d'urgence (Daoust, Huard, Lessard, Cournoyer), Faculté de médecine, Université de Montréal, Montréal, Que.; Département de médecine de famille et de médecine d'urgence (Émond), Faculté de Médecine, Université Laval; Département d'urgence du CHU-Québec (Émond), Québec, Que.; Department of Emergency Medicine (Iseppon), Hôpital Maisonneuve-Rosemont; Centre de recherche de l'Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île-de-Montréal) (Williamson, Lavigne); Faculté de Pharmacie (Williamson), Université de Montréal, Montréal, Que.; Division of Emergency Medicine (Yan), Department of Medicine, Western University, London Health Sciences Centre, London, Ont.; Department of Emergency Medicine (Perry), University of Ottawa, Ottawa, Ont.; Faculties of Dental Medicine and Medicine (Lavigne), Université de Montréal, Montréal, Que.; Department of Emergency Services and Scientist (Lee), Clinical Epidemiology Unit, Sunnybrook Health Sciences; Schwartz/Reisman Emergency Medicine Institute (Lee), Mount Sinai Hospital, Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta. raoul.daoust@umontreal.ca.
• CMAJ. 2024 Jul 14; 196 (25): E866E874E866-E874.

BackgroundUnused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids.MethodsIn a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period.ResultsWe included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets).InterpretationTwo-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse.Trial RegistrationClinicalTrials.gov, no. NCT03953534.© 2024 CMA Impact Inc. or its licensors.

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