Study to Test Ways To Discuss Opioid Risks With ER Patients

To work toward lowering the risk of opioid dependence in patients who receive medications for pain syndromes while in the hospital, doctors from Northwell Health are collaborating with the University of Pennsylvania and the Mayo Clinic to study 2 methods of educating patients in the ER about the risks of opioid addiction.

Karin Rhodes, MD, vice president of care management design and evaluation in the Office of Population Health Management at Northwell Health, and colleagues are enrolling 400 patients from each hospital for a total of 1200 patients who present in emergency departments with lower back pain or with pain due to kidney stones.

Traditionally, patients with pain from these conditions are prescribed opioids, but non-steroidal, anti-inflammatory medication has been found just as effective for treating pain.

“While treatment with opioids for these conditions has been a standard treatment, patients can easily become dependent on these medications without realizing it,” Dr Rhodes said in a statement. “We want to see whether people who understand the risk, and in particular their risk, will be less likely to choose an opioid as a pain reliever. We want to balance good pain management with engaging the patient in informed decision-making to help them opt for the best choice of therapy for them.”

The first method the researchers designed is a questionnaire and visual risk spectrum showing patients their individual risk for addiction, based on factors that are considered red flags, such as a family or individual history of drug or alcohol abuse.

The second method is the questionnaire along with a video of people sharing their stories of receiving an opioid prescription from an emergency department (ED) which lead them to become addicted to opioids.  

“Our study was inspired by one of our own nurses who became addicted after being treated with an opioid in the University of Pennsylvania emergency department for a minor injury. He began stealing drugs from work and his life spiraled out of control until he ultimately sought treatment and recovered. He wanted to share his story to make sure others are warned of the risks; people learn by stories,” said Dr Rhodes.

The researchers will randomly present one of the interventions during patients’ visits to the ED, and will track whether patients and their ER physicians choose prescription opioids or non-steroidal anti-inflammatory medication at discharge. The patients will be followed up for the next 3 months via text message: they will be texted once every day for 1 week about their medication intake and pain levels, and then once a week for the next 3 months. The researchers will also ask the patients when they anticipate returning to work. At 3 months, feedback will be sought from patients to determine how satisfied they were with their functional status and overall pain care.

The researchers’ goal is to determine the amount of opioid pain medication the patients take, and the number of days during which they take opioids over the 3 months following their initial assessment. The researchers hypothesize that those who view the video with real-life narratives will take less opioids on fewer days without experiencing more pain, and that they may also resume work earlier because taking fewer opioids would allow them to drive sooner.

Because an estimated 42% of ER visits are pain-related, avenue of treatment decided upon then has important consequences on future events. “Because pain management is tracked as a hospital quality measure in patient satisfaction surveys, there has been tremendous pressure for providers to prescribe opioids,” said Dr Rhodes. “Individualized prevention may be the key to addressing the opioid epidemic.”

Northwell Health (formerly North Shore-LIJ Health System) will receive $350 000 over 3 years from the Patient Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization based in Washington, DC.