A recent study evaluated optimal opioid prescribing practices to reduce unused medications following emergency department visits for acute pain. The objective was to determine appropriate opioid quantities to meet patients' analgesic needs while minimizing unused opioids.

This prospective, multi-center cohort study, published in the Canadian Medical Association Journal, included 2240 patients aged 18 years and older (mean age 51 years, 48% female) with acute pain conditions of less than 2 weeks' duration, who were discharged from emergency departments (ED) with opioid prescriptions. Participants maintained a pain medication diary for 14 days, recording their analgesic use, and were followed up by phone after 2 weeks.

The median consumption was 5 morphine 5-mg tablet equivalents, with significant variation by pain condition (P < .001). Patients with renal colic or abdominal pain required 8 morphine 5-mg tablet equivalents, whereas those with fractures required 24 tablets, back pain 21 tablets, neck pain 17 tablets, and other musculoskeletal pain 16 tablets.

Notably, 63% of opioids prescribed after ED visits remained unused. Daily usage patterns showed a gradual decrease in opioid use over the 14-day period, with concurrent use of NSAIDs and acetaminophen.

The authors suggest tailoring prescriptions to specific pain conditions and consider practices such as partitioned dispensing and adding expiration dates to prescriptions to limit unused opioids.

Limitations of the study included potential selection bias and limited generalizability due to most participants being from 1 province.

These findings have implications for opioid prescribing practices in EDs and could potentially impact opioid misuse by reducing the number of unused tablets available for diversion.

The study was funded by the Canadian Institutes of Health Research. Full disclosures can be found in the published study.