Are Opioids Really Needed In Hospital Emergency Rooms?

The opioid crisis in America has become an epidemic, with drug overdose a leading cause of death. The two most popular opioid prescriptions written in the U.S. are for oxycodone and hydrocodone (typically Vicodin); the effects of both drugs apparently “indistinguishable from the effects of heroin” on the brain.

In the last 20 years, prescriptions for opioids have increased, as have drug addictions and drug-related deaths. Opioids aren’t just prescribed for surgery recovery anymore. They’re also distributed for more routine ailments, like chronic pain, which is just one reason the circulation of opioids has increased.

Yet according to research published in the Journal of the American Medical Association, opioids don’t do much more for pain than ibuprofen or acetaminophen. In a clinical trial, 411 emergency department patients with extreme pain were randomly treated with opioids versus non-opioids. Ibuprofen and acetaminophen reduced pain scores by 4.3. The only patients who saw a greater decrease in their pain were those treated with oxycodone — and their pain was only reduced by 4.4.

Some patients treated with opioids, or a combination of opioids and non-opioids, found their pain a lot worse than those treated with ibuprofen and acetaminophen. Patients treated with a combination of hydrocodone and acetaminophen only found their pain decreased by 3.5.

The conclusion here is that these emergency department patients did not feel significantly more relief when treated with an opioid. If the drug crisis increase is running parallel to the increase in opioid prescriptions, then this is a valuable finding. The choice to opt for an opioid over a non-opioid for acute emergency pain doesn’t seem to be backed by much. And, in fact, now there’s evidence that suggests we should opt for the non-opioid treatment. In most cases, why not prescribe the less addictive option for pain relief?