Monday, February 10, 2025

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 Journalhttps://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.

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 FacebookXLinkedIn and Instagram.

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