Abstract:

Background and Objectives: Studies have demonstrated that opioids have different addictive properties and abuse potential. Oxycodone continues to be one of the most commonly prescribed medications for pain management in the emergency department (ED) despite its increased abuse liability. Our objective was to determine whether oral immediate-release morphine is as effective and well tolerated as oral oxycodone/acetaminophen for pain relief in ED patients.

Methods: This is a prospective comparative study that took place in an urban, academic ED from 2016-19. Stable patients who had either oral morphine (15 or 30 mg) or oxycodone/acetaminophen (5/325 mg or 10/650 mg) ordered for them at the discretion of a triage physician were recruited. They were asked to rate their pain score prior to receiving analgesia and at 60 and 90 minutes after administration, adverse effects, overall satisfaction, and their willingness to accept the same treatment again. Charts were reviewed to determine if additional analgesia was needed. Continuous variables were described using medians and the Wilcoxon rank sum test/Kruskal Wallis test were used to examine differences between the groups. Categorical variables were described using frequencies/percentages and the Chi-square and Fisher exact tests were used. Statistical significance was defined as P < 0.05.

Results: Of 364 enrolled patients, 182 were given oral morphine and 182 were given oxycodone/acetaminophen. 73% of the subjects were between the ages of 18 and 59, 57% were female and 85% were African American. Most presented with abdominal, extremity, or back pain. Patient characteristics were similar between treatment groups. There was no difference in satisfaction reported by patients who received morphine versus oxycodone/acetaminophen: 15.9% vs. 16.5% were very satisfied, 31.9% vs. 26.4% were somewhat satisfied and 23.6% vs. 22.5% were not satisfied, p = 0.56. Secondary outcomes also showed no significant difference: net change in pain score -2 vs. -2 at 60 and 90 minutes, p = 0.91, p = 0.72; adverse effects 20.9% vs. 19.2%, p = 0.69; need for further analgesia 9.3% vs. 7.1%, p = 0.44; willingness to accept analgesic again 73.1% vs. 78.6%, p = 0.22.

Conclusion: There was no difference in efficacy or adverse effects with oral morphine versus oxycodone/acetaminophen, suggesting oral morphine may be a feasible alternative with less abuse liability in the ED.