Hall et al. draw attention to the important question of whether some patients may benefit from a naloxone prescription when discharged from the hospital with a short-term opioid prescription for acute pain. Although all members of the working group agreed that naloxone is appropriate in some cases, we were hesitant to recommend this as standard practice for several reasons.
First, the intent of our Consensus Statement1 was to synthesize and summarize areas of consensus in existing guidelines; none of the existing guidelines included in our systematic review make a recommendation for naloxone prescribing in the setting of short-term opioid use for acute pain.2 We believe this may relate to the fact that the risk factors for overdose and threshold of risk above which naloxone would be beneficial have yet to be defined for this population, and are likely to differ from those defined in patients using opioids chronically.
Additionally, if practitioners follow recommendations to limit prescribing for acute pain to the minimum dose and duration of an opioid that was presumably administered in the hospital with an observed response, then the risk of overdose and the potential benefit of naloxone will decrease. Furthermore, emerging data from randomized controlled trials demonstrating non-inferiority of non-opioid analgesics in management of acute pain suggest that we should not so readily presume opioids to be the necessary or best option.3–5 Data questioning the benefits of opioids over other safer therapies have particularly important implications for patients in whom the risks are felt to be high enough to warrant consideration of naloxone.
Acknowledgments
Financial support: Dr. Herzig is funded by grant number K23AG042459 from the National Institute on Aging. Dr. Mosher is supported in part by the Department of Veterans Affairs Office of Academic Affiliations and Office of Research and Development and Health Services Research and Development Service (HSR&D) through the Comprehensive Access and Delivery Research and Evaluation Center (CIN 13-412). The views expressed in this manuscript do not necessarily represent the views of the funding agencies.
Footnotes
Disclosures: Dr. Herzig reports receiving compensation from the Society of Hospital Medicine for her editorial role at the Journal of Hospital Medicine (unrelated to the present work). None of the other authors have any conflicts of interest to disclose.
References
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