Oxycodone induced euphoria in ED patients with acute musculoskeletal pain. A secondary analysis of data from a randomized trial

Sapkota, Abishake; Takematsu, Mai; Adewunmi, Victoria; Gupta, Chiraag; Williams, Andrew; Friedman, Benjamin W.

doi:10.1016/j.ajem.2022.01.016

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Questions were standardised and identical wording, scales and anchors were used across measurement times and formats (a complete list is included in online Supporting Information Appendix S1) having been piloted in patient populations. Single item questions are typically well‐understood by respondents and can be completed within seconds, which was essential to capture the immediate effects of opioids [33–35]. An 11‐point (0–10) NRS which transfers well between the written and the verbal response format was used for all key measures.…”

Section: Methodsmentioning

confidence: 99%

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Opioid analgesic effects on subjective well‐being in the operating theatre*

et al. 2023

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Summary Exposure to opioid analgesics due to surgery increases the risk of new persistent opioid use. A mechanistic hypothesis for opioids' abuse liability rests on the belief that, in addition to pain relief, acute opioid treatment improves well‐being (e.g. via euphoria) and relieves anxiety. However, opioids do not consistently improve mood in laboratory studies of healthy non‐opioid users. This observational study determined how two commonly used opioid analgesics affected patients' subjective well‐being in standard clinical practice. Day surgery patients rated how good and how anxious they felt before and after an open‐label infusion of remifentanil (n = 159) or oxycodone (n = 110) in the operating theatre before general anaesthesia. One minute after drug injection, patients reported feeling intoxicated (> 6/10 points). Anxiety was reduced after opioids, but this anxiolytic effect was modest (remifentanil Cohen's d = 0.21; oxycodone d = 0.31). There was moderate to strong evidence against a concurrent improvement in well‐being (Bayes factors > 6). After remifentanil, ratings of ‘feeling good’ were significantly reduced from pre‐drug ratings (d = 0.28). After oxycodone, one in three participants felt better than pre‐drug. Exploratory ordered logistic regressions revealed a link between previous opioid exposure and opioid effects on well‐being, as only 14 of the 80 opioid‐naïve patients reported feeling better after opioid injection. The odds of improved well‐being ratings after opioids were higher in patients with previous opioid exposure and highest in patients with > 2 weeks previous opioid use (adjusted OR = 4.4). These data suggest that opioid‐induced improvement of well‐being is infrequent in opioid‐naïve patients. We speculate that peri‐operative exposure could increase risk of persistent use by rendering subsequent positive opioid effects on well‐being more likely.

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Section: Methodsmentioning

confidence: 99%

“…Single item questions are typically well-understood by respondents and can be completed within seconds, which was essential to capture the immediate effects of opioids [33][34][35]. An 11-point (0-10) NRS which transfers well between the written and the verbal response format was used for all key measures.…”

Section: Methodsmentioning

confidence: 99%

Opioid analgesic effects on subjective well‐being in the operating theatre*

et al. 2023

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“…To measure feeling high and euphoria, we relied on instruments originally developed as part of the Addiction Research Center Inventory, a comprehensive questionnaire used to determine the subjective effects of psychoactive substances [12]. The items we used have been validated for use among recreational opioid users [13,14] and refined among ED patients with acute pain [4][5][6]. For this study, we used a two-item instrument: (1) What was your level of feeling high with the medication?…”

Section: Measurementsmentioning

confidence: 99%

“…Some patients do not experience pain relief when administered therapeutic doses of intravenous (IV) opioids [1][2][3]. Similarly, emergency department (ED) patients with acute pain exposed to opioids report variable euphoric experiences, with many reporting no euphoria or dysphoric reactions [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Use of clinical phenotypes to characterize emergency department patients administered intravenous opioids for acute pain

Caplan¹,

Friedman²,

Siebert³

et al. 2023

Clin Exp Emerg Med

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Objective Individual experience with opioids is highly variable. Some patients with acute pain do not experience pain relief with opioids, and many report no euphoria or dysphoric reactions. In this study, we describe the clinical phenotypes of patients who receive intravenous opioids.Methods This was an emergency department-based study in which we enrolled patients who received an intravenous opioid. We collected 0 to 10 pain scores prior to opioid administration and 15 minutes after. We also used 0 to 10 instruments to determine how high and how much euphoria the patient felt after receipt of the opioid. Using a cutoff point of ≥50% improvement in pain and the median score on the high and euphoria scales, we assigned each participant to one of the following clinical phenotypes: pain relief with feeling high or euphoria, pain relief without feeling high or euphoria, inadequate relief with feeling high or euphoria, and inadequate relief without feeling high or euphoria.Results A total of 713 patients were enrolled, 409 (57%) of whom reported not feeling high, and 465 (65%) reported no feeling of euphoria. Median percent improvement in pain was 37.5% (interquartile range, 12.5%–60.0%). One hundred seventy-eight participants (25%) were classified as experiencing pain relief with euphoria or feeling high, 190 (27%) experienced inadequate relief with euphoria or feeling high, 101 (14%) experienced pain relief without euphoria or feeling high, and 244 (34%) reported inadequate relief without euphoria or feeling high.Conclusion Among patients who receive intravenous opioids in the emergency department, the experiences of pain relief and euphoria are highly variable. For many, pain relief is independent of feeling high.

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