Opioid prescribing should be adapted to specific conditions to reduce the risk of misuse from diverted unused medication, according to Canadian research presented at the recent European Emergency Medicine Congress. 

Researchers enrolled 2,240 adults, aged on average 51 years, who presented to emergency departments. Patients experienced acute pain for less than two weeks and were discharged with an opioid prescription. Participants completed a pain medication diary for two weeks.

During the two weeks, patients consumed a median of five tablets, which resulted in 63 per cent of opioid tablets going unused. To adequately supply 80 per cent of patients for two weeks, those with renal colic or abdominal pain needed eight 5mg morphine or equivalent tablets compared with 24 tablets for patients with fractures, 21 and 17 for those with back and neck pain respectively, and 16 for other musculoskeletal pains. 

Two-thirds of patients consumed opioids on the first day after discharge, which decreased to 12 per cent at the end of follow-up.   

“With this research I wanted to provide a tailored approach to prescribing opioids so that patients have enough to manage their pain but almost no unused tablets available for misuse,” says lead author Professor Raoul Daoust from the University of Montreal. 

“We found that, in general, patients consume few opioids, but this varies depending on the type of painful condition. Our findings make it possible to adapt the quantity of opioids we prescribe according to patient need. We could ask the pharmacist to also provide opioids in small portions, such as five tablets initially, because for half of patients that would be enough to last them for two weeks.”

The researchers now aim to evaluate the impact of prescriptions tailored to a specific condition on long-term opioid use and misuse.