Opioid Overdose Risk in Patients Returning to the Emergency Department for Pain

Author:

Sheikh Sophia1ORCID,Booth-Norse Ashley1,Holden David1,Henson Morgan1,Dodd Caroline1,Edgerton Eric1,James Divya2,Kalynych Colleen1,Smotherman Carmen3,Hendry Phyllis1

Affiliation:

1. University of Florida College of Medicine-Jacksonville, Jacksonville, Florida

2. University of Florida College of Medicine, Gainesville, Florida

3. Center for Health Equity and Quality Research, University of Florida College of Medicine-Jacksonville, Florida, USA

Abstract

Abstract Objective Using the Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD) in patients returning to the emergency department (ED) for pain and discharged with an opioid prescription, we assessed overall opioid overdose risk and compared risk in opioid naive patients to those who are non-opioid naive. Design This was a secondary analysis from a prospective observational study of patients ≥ 18 years old returning to the ED within 30 days. Data were collected from patient interviews and chart reviews. Patients were categorized as Group 1 (not using prescription opioids) or Group 2 (consuming prescription opioids). Statistical analyses were performed using Fisher’s exact and Wilcoxon’s rank sum tests. Risk class and probability of overdose was determined using Risk Index for Overdose or Serious Opioid-induced Respiratory Depression (CIP-RIOSORD). Results Of the 389 enrollees who returned to the ED due to pain within 30 days of an initial visit, 67 (17%) were prescribed opioids. The majority of these patients were in Group 1 (60%). Both Group 1 (n = 40) and Group 2 (n = 27) held an average CIP-RIOSORD risk class of 3. Race significantly differed between groups; the majority of Group 1 self-identified as African American (80%) (P = .0267). There were no differences in age, gender, or CIP-RIOSORD risk class between groups. However, Group 2 had nearly double the number of predictive factors (median = 1.93) as Group 1 (median = 1.18) (P = .0267). Conclusions A substantial proportion of patients (25%) were high risk for opioid overdose. CIP-RIOSORD may prove beneficial in risk stratification of patients discharged with prescription opioids from the ED.

Funder

Dean’s Fund for Research Award from the University of Florida College of Medicine- Jacksonville

Jacksonville Aging Studies Center (JAX-ASCENT

NIH National Center for Advancing Translational Sciences

NIH

Publisher

Oxford University Press (OUP)

Subject

Anesthesiology and Pain Medicine,Clinical Neurology,General Medicine

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