Opioid prescriptions in the emergency department (ED) linked to small increases in future opioid use, hospitalizations
Canadian Medical Association Journal
Opioid prescriptions in the emergency department (ED) were associated with small increases in later opioid prescriptions and hospital admissions, found new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.241542.
To understand the relationship between opioid prescribing in the ED and subsequent harm, researchers looked at opioid prescribing at all Alberta EDs from 2010 to 2020. Of the more than 13 million visits, 689 074 patients (5.3%) filled an opioid prescription. The researchers found that opioid prescriptions did not increase the risk of death or overdose, but that opioid-treated patients were more likely than untreated controls to require a hospital admission (16.4% v. 15.1%) or to receive additional opioid prescriptions (4.5% v. 3.3%) in the year following the ED visit.
“Emergency physicians face growing pressure to curtail opioid prescribing but must manage severe pain and treat opioid-tolerant patients who can no longer access opioids from their physicians,” writes Dr. Grant Innes, professor of emergency medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, with coauthors. “There is little research to guide them.”
The researchers concluded that although single opioid prescriptions are not risk free, the likelihood of harm is low and unlikely to outweigh the benefit of treating severe pain. Their findings also show that patient characteristics influence risk and that adverse outcomes are more likely with opioid-naive patients, older patients, patients with multiple health conditions, and frequent ED users.
“Physicians should understand the concept of patient-specific incremental risks when prescribing opioids for acute pain and prescribe cautiously within high-risk groups,” the authors conclude.
They also suggest that future research should investigate the effects of different opioid drugs, which may not be equal, and identify health conditions where opioid risk is more or less severe.
“Research and guidance in this area is long overdue, and only filling this research gap will allow acute pain prescribers and their patients to consider how best to ameliorate pain while minimizing potential harms related to opioid prescription,” writes Dr. Donna Reynolds, a family physician and acting co-chair of the Canadian Task Force on Preventive Health Care, with coauthors in a related commentary https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250094.
Journal
Canadian Medical Association Journal
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
Effect of emergency department opioid prescribing on health outcomes
Article Publication Date
10-Feb-2025
Does pain affect cancer survivors’ use of non-opioid substances?
U.S. data indicate that pain is linked with a greater likelihood of tobacco and cannabis use among cancer survivors.
Wiley
Experiencing pain may increase the odds that cancer survivors will use cigarettes and cannabis, according to a recent study published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society. The study also found that cigarette smoking and pain are linked to more treatment-related side effects and worse health among cancer survivors.
Pain and use of cigarettes, e-cigarettes, alcohol, and cannabis commonly occur together in the general population. To characterize pain in relation to such non-opioid substance use specifically among cancer survivors (who often experience pain), investigators analyzed data from two national samples of individuals with a past diagnosis of cancer in the United States: 1,252 adults from Wave 6 (2021) of the Population Assessment of Tobacco and Health (PATH) Study and 4,130 adults from the 2020 National Health Interview Survey.
PATH data indicated that higher past-week pain intensity was associated with a greater likelihood that cancer survivors would use cigarettes, e-cigarettes, and cannabis, and a lower likelihood that they would drink alcohol. National Health Interview Survey data indicated that chronic pain was associated with a greater likelihood of cigarette smoking and a lower likelihood of alcohol use. In both studies, cigarette smoking and pain were linked to fatigue, sleep difficulties, poorer mental/physical health, and lower quality of life.
“These findings show that because pain and substance use are interconnected among cancer survivors, it’s important to focus on treating both together in cancer care. Pain can drive substance use, and substance use can worsen pain, creating a cycle that’s hard to break,” said lead author Jessica M. Powers, PhD, of Northwestern University’s Feinberg School of Medicine. “While cancer survivors might smoke cigarettes or use substances to get immediate relief from their pain and cope with other symptoms, this can be incredibly harmful for their health by reducing the effectiveness of cancer treatments and increasing risk for cancer recurrence.”
Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com
Full Citation:
“Relationship Between Pain and Non-Opioid Substance Use in Two National Samples of Cancer Survivors.” Jessica M. Powers, Lisa R. LaRowe, Dana Rubenstein, Judith A. Paice, Brian Hitsman, and Christine M. Rini. CANCER; Published Online: February 10, 2025 (DOI: 10.1002/cncr.35701).
URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35701
Author Contact: Kristin Samuelson at ksamuelson@northwestern.edu
About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.
About Wiley
Wiley is one of the world’s largest publishers and a trusted leader in research and learning. Our industry-leading content, services, platforms, and knowledge networks are tailored to meet the evolving needs of our customers and partners, including researchers, students, instructors, professionals, institutions, and corporations. We empower knowledge-seekers to transform today’s biggest obstacles into tomorrow’s brightest opportunities. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, X, LinkedIn and Instagram.
Journal
Cancer
Article Title
Relationship Between Pain and Non-Opioid Substance Use in Two National Samples of Cancer Survivors
Article Publication Date
10-Feb-2025
Study shows initial success but long-term challenges of 2019 Medicare opioid safety policy
Key points:
- A new study led by the Harvard Pilgrim Health Care Institute examined the effects of a January 2019 Medicare opioid safety policy aimed at reducing high-risk opioid prescribing and related harms among these beneficiaries.
- Though the policy was associated with immediate reductions in initial prescription duration and concurrent multiple-prescriber high-dosage episodes, these reductions decreased over time, highlighting the need for further interventions to address clinical and social risk factors of opioid misuse.
Boston, MA – A new study led by researchers at the Harvard Pilgrim Health Care Institute found that a 2019 Medicare opioid safety policy showed initial reductions in opioid prescribing to high-risk populations. However, the policy’s effectiveness diminished over time.
The study was published in JAMA Internal Medicine on February 10.
Medicare provides coverage for 9 million U.S. adults with disabilities under the age of 65. Despite representing only 3% of the U.S. population, these beneficiaries account for 25% of opioid-related overdose deaths and hospitalizations. On January 1, 2019, the Centers for Medicare & Medicaid Services (CMS) required all Medicare Part D plans to implement an opioid safety policy. This policy limits new opioid users to a 7-day supply and restricts prescriptions to no more than 90 morphine milligram equivalents daily.
Harvard Pilgrim Health Care Institute researchers and collaborators examined whether the policy led to shorter initial opioid prescriptions and reduced progression to long-term use among new users, as well as fewer high-dosage prescriptions from multiple prescribers among long-term users, without disrupting stable high-dose opioid therapy or causing adverse events.
“As the ongoing opioid crisis impacts high-risk groups such as disabled Medicare beneficiaries, it is imperative to evaluate policies designed to reduce these harms,” said Hefei Wen, Harvard Medical School assistant professor of population medicine at the Harvard Pilgrim Health Care Institute and lead author of the study. “We have the data and the methods to produce evidence that policymakers should consider when adjusting these policies to the unique needs of these vulnerable populations.”
The study analyzed a rolling cohort of Medicare beneficiaries with disabilities using Optum’s deidentified Clinformatics Data Mart database. The analysis covered a 31-month pre-policy period (June 2016 to December 2018) and a 33-month post-policy implementation period (January 2019 to September 2021). The team prioritized two cohorts within the study population: new users, identified by an initial opioid fill after a 3-month opioid-free period; and long-term users, defined by an opioid duration of 60 days or longer with 80 or more total days’ supply within a 4-month window.
Results suggest that the 2019 Medicare opioid safety policy reduced the length of initial opioid prescriptions and the frequency of high-dose prescriptions from multiple-prescribers among Medicare beneficiaries with disabilities. While the 7-day safety edit led to immediate and sustained reductions in initial opioid prescriptions exceeding 7 days, these reductions diminished by the end of the study period. The 90-MME limit resulted in an immediate reduction in concurrent multiple-prescriber high-dosage episodes; though this effect was reversed when COVID-19 flexibilities rolled back the 90-MME edit. These findings, the researchers say, show that the work to curtail the opioid crisis should remain ongoing, evolving, and evidence-based.
“While our analysis reveals immediate reductions in high-risk opioid prescribing, our analyses show that these reductions diminished over time, highlighting the need for further research to understand crucial downstream policy effects and subpopulations at risk,” added Dr. Wen. “Policymakers and insurers should consider additional clinical and culturally nuanced interventions that address medical and social risk factors of opioid misuse.”
About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky, X, and LinkedIn.
Journal
JAMA Internal Medicine
Article Title
Association of the 2019 Medicare Opioid Policy with Opioid Use in Beneficiaries with Disabilities
Article Publication Date
10-Feb-2025
