Patients’ Desires to Receive Opioids in the Emergency Department After a Patient-Centered Discussion: A Randomized Trial With Hypothetical Vignettes

We hypothesized that emergency department (ED) patients with painful conditions may be more likely to decline opioid pain medicines when they consider the connection between receiving opioids in the ED and the subsequent risk of opioid dependence or addiction. Therefore, we assessed patients' willingness to decline opioid pain medicines after a brief patient-centered discussion.

We conducted a cross-sectional survey of randomly sampled ED patients, with embedded randomization for participants to receive a patient centered discussion (intervention) or no discussion (control). The intervention consisted of a brief (less than 2-minute) discussion on the risks/benefits of receiving opioids in the ED. The primary outcome of interest was patients’ desire to receive morphine after considering a hypothetical vignette of a fractured ankle. To limit the influence of Hawthorne effect, prior awareness of opioid risks was measured in the control group. The effect of the intervention was described using absolute risk reduction [ARR] and relative risk (modified Poisson analysis), with 95% confidence internals.

Among the total 175 patients, mean age was 49.9 (SD=18.8), mean NRS pain scores were 6.0 (SD=2.7), with 54.9% of patients identifying as female, 60% as white, and 23.4% as black. Among the 86 patients randomized to the control group, 77.9% (n=67) believed that opioid prescriptions purchased at a drug store could lead to addiction, while 43% (n=37) believed that opioids given in the ED could lead to addiction. After all patients (n=175) received the hypothetical vignette of a fractured ankle, 20.2% (18/89) of patients in the intervention group desired morphine compared to 62.8% (54/86) in the control group [ARR 42.6% (95% CI 23.4%-61.7%)]. Modified Poisson analysis showed that patients who received the intervention were 0.32 times (95% CI 0.19-0.55) less likely to opt for morphine than those in the control.

The study findings suggest that most patients are not aware of the association between receiving opioids in the ED and the risk of dependence or addiction. The findings also suggest that a brief patient-centered discussion, focused on the risks/benefits of receiving opioids in the ED, might sway patients to decline opioids for painful ED conditions. Further research is needed to confirm these findings in real-life scenarios.