While the frequency of short-term side effects of opioids are well-known, the long-term risks of opioid use are inadequately quantified. For a study published in Annals of Emergency Medicine, my colleagues from two emergency departments in the Bronx, NY, and I sought to determine how frequently opioid-naïve patients—treated for acute pain in an ED and discharged home with a prescription for an oral opioid—developed persistent opioid use. The goal of the study was to quantify this risk, so that informed decisions could be made about the long-terms risks of oral opioids among patients with acute pain. This prospective cohort study enrolled 484 patients during an initial ED visit and followed them for 6 months. At the time of the initial visit, patients needed to be opioid-naïve—which we defined as no use of opioids within the preceding 6 months—and suffering with acute pain of sufficient severity to warrant the use of opioids. Over the next 6 months, two-thirds of patients filled only the opioid prescription they received in the ED, one in five filled at least one subsequent prescription, and only five (1%) filled prescriptions persistently throughout the study period. Persistent opioid use was strongly linked to persistent moderate or severe pain.

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Based on these data, we concluded that it is reasonable to use opioids judiciously for opioid-naïve ED patients with acute pain. In this study, as in others, the total number of opioid pills prescribed was associated with likelihood to progress to persistent opioid use, so we caution clinicians to prescribe the lowest reasonable number of pills. Also, interestingly, it was impossible to predict poor outcomes based on features of the patient or the initial visit. Even use of the standard Opioid Risk Tool did not help. In future studies, we intend to determine the association between opioid-induced euphoria and poor outcomes.