Limiting Opioid Prescribing

To the Editor The Viewpoint by Dr Chua and colleagues discussed opioid prescribing limits for treatment of acute pain. I agree that uniform limits based on 5- or 7-day supplies are problematic. For a 5-day supply, up to 60 pills can be prescribed. However, a previous study reported that opioid consumption during the first 2 weeks after an emergency department visit for acute pain was a median of seven 5-mg morphine pills (or equivalent). To adequately supply 80% of patients, the study estimated that 30 pills would be sufficient for patients with fractures, 15 for those with renal colic, and 20 for those with other conditions. With the proposed 5-day supply of 60 pills, many patients will have in their possession a significant number of residual opioid pills available for misuse. Moreover, co-analgesic use should be optimized. Most US studies use combinations of opioids and acetaminophen, which prevents many patients from adequately optimizing their daily acetaminophen dosage.

Source: JAMA - July 9, 2019 Category: General Medicine Source Type: research