Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study

BMJ Open. 2018 Sep 17;8(9):e022649. doi: 10.1136/bmjopen-2018-022649.


Objectives: Prescription opioid diversion is a significant contributor to the opioid misuse epidemic. We examined the quantity of opioids consumed by emergency department (ED) discharged patients after treatment for an acute pain condition (musculoskeletal, fracture, renal colic, abdominal pain and other), and the percentage of unused opioids available for potential misuse.

Design: Prospective cohort study.

Setting: Tertiary care trauma centre academic hospital.

Participants: A convenience sample of patients ≥18 years who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day paper diary of daily pain medication use. To reduce lost to follow-up, participants also responded to standardised phone interview questions about their previous 14-day pain medication use.

Outcomes: Quantity of morphine 5 mg tablets (or equivalent) prescribed, consumed and unused during a 14-day follow-up. Quantity of opioids to adequately supply 80% of patients for 2 weeks and 95% of patients for the first 3 days was also calculated.

Results: Results for 627 patients were analysed (mean age ±SD: 51±16 years, 48% women). Patients consumed a median of seven tablets of morphine 5 mg (32% of the total prescribed opioids). The quantity of opioids to adequately supply 80% of patients for 2 weeks was 20 tablets of morphine 5 mg for musculoskeletal pain, 30 for fracture, 15 for renal colic or abdominal pain and 20 for other pain conditions. The quantity to adequately supply 95% of patients for the first 3 days was 15 tablets of morphine 5 mg.

Conclusions: Patients discharged from the ED with an acute pain condition consumed a median of fewer than 10 tablets of morphine 5 mg (or equivalent). ED physicians should consider prescribing a smaller quantity of opioids and asking the pharmacist to dispense them in portions to minimise unused opioids.

Trial registration number: NCT02799004; Results.

Keywords: acute pain; emergency department; opioids; pain management; substance misuse.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Pain / drug therapy
  • Acute Pain / drug therapy*
  • Acute Pain / etiology
  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use*
  • Canada
  • Diaries as Topic
  • Drug Prescriptions / statistics & numerical data*
  • Emergency Service, Hospital
  • Female
  • Fractures, Bone / complications
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Morphine / therapeutic use*
  • Musculoskeletal Pain / drug therapy
  • Practice Patterns, Physicians'
  • Prospective Studies
  • Renal Colic / drug therapy
  • Telephone


  • Analgesics, Opioid
  • Morphine

Associated data

  • ClinicalTrials.gov/NCT02799004