CMAJ

Emergency department opioid prescribing: How risky is it?

February 13, 2025

While opioid prescriptions didn't increase the risk of death or overdose, patients who received them were more likely to need hospital admission or additional opioid prescriptions within a year compared with untreated controls.

Study design: This retrospective cohort study utilized administrative data from Alberta ED visits over a 10-year period. Patients who filled an opioid prescription within 72 hours of their ED visit were compared with propensity-matched controls who didn't receive opioids. The primary composite outcome included opioid-related ED visits, new opioid agonist therapy, all-cause hospital admission, or death within one year. The secondary outcome was prolonged opioid use.

Results: Out of 13,028,575 eligible visits, 689,074 patients (5.3%) filled an opioid prescription. Patients who received opioids had a 1.4% higher rate of primary outcome events (17.1% vs. 15.7%), primarily driven by increased all-cause hospital admissions (16.4% vs. 15.1%; number needed to harm [NNH] = 53) and prolonged opioid use (4.5% vs. 3.3%; NNH = 59). There wasn't a significant difference in opioid-related visits, new opioid agonist therapy, or mortality. Incremental risk was highest among opioid-naive patients, older patients, and males.

Source:

Hayward J, et al. (2025, February 9). CMAJ. Effect of emergency department opioid prescribing on health outcomes. https://pubmed.ncbi.nlm.nih.gov/39929491/