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West J Emerg Med. 2018 Jul;19(4):722-730. doi: 10.5811/westjem.2018.4.37019. Epub 2018 Jun 11.

Patient Preference for Pain Medication in the Emergency Department Is Associated with Non-fatal Overdose History.

Author information

1
University of Washington, Department of Emergency Medicine, Seattle, Washington.
2
University of Michigan Medical School, University of Michigan Injury Center, Ann Arbor, Michigan.
3
University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.
4
University of Michigan Medical School, Addiction Center and Department of Psychiatry, Ann Arbor, Michigan.
5
VA Center for Clinical Management Research, Department of Veterans Affairs Healthcare System, Ann Arbor, Michigan.

Abstract

Introduction:

Opioid overdose is a major public health problem. Emergency physicians need information to better assess a patient's risk for overdose or opioid-related harms. The purpose of this study was to determine if patient-reported preference for specific pain medications was associated with a history of lifetime overdose among patients seeking care in the emergency department (ED).

Methods:

ED patients (18-60 years) completed a screening survey that included questions on overdose history, ED utilization, opioid misuse behaviors as measured by the Current Opioid Misuse Measure (COMM), and analgesic medication preferences for previous ED visits for pain with specific responses for preference for hydromorphone (DilaudidĀ®), morphine, ketorolac (ToradolĀ®), "no preference" or "never visited the ED for pain." We compared individuals who reported a lifetime history of overdose descriptively to those without a lifetime history of overdose. Logistic regression was used to determine factors associated with a history of overdose.

Results:

We included 2,233 adults in the analysis (71.5% response rate of patients approached) with 532 reporting at least one lifetime overdose. In the univariate analysis, medication preference was significantly associated with overdose history (p < .001); more patients in the overdose group reported preferring morphine and hydromorphone and those without a history of overdose were more likely to have no preference or say they had never visited the ED for pain. In the logistic regression analysis, patients with higher odds of overdose included those of Caucasian race, participants with a higher COMM score, preference for ketorolac, morphine or hydromorphone. Those who were younger, female and reported never having visited the ED for pain had lower odds of reporting a lifetime overdose. Having "any preference" corresponded to 48% higher odds of lifetime overdose.

Conclusion:

Patients with a pain medication preference have higher odds of having a lifetime overdose compared to patients without a specific pain medication preference, even after accounting for level of opioid misuse. This patient-reported preference could cue emergency physicians to identifying high-risk patients for overdose and other substance-related harms.

PMID:
30013710
PMCID:
PMC6040914
DOI:
10.5811/westjem.2018.4.37019
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. The study was registered with clinicaltrials.gov, the protocol was reviewed and approved by the University of Michigan Institutional Review Board, and a National Institutes of Health Certificate of Confidentiality was obtained. The SPOS study was supported by CDC grant R49CE002099. The funding sources had no role in the design of the study or the reporting of the study.

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