Study confirms recommended interventions are essential to reduce opioid distribution

Australian researchers have completed a review of a trial aimed at reducing the distribution of opioids in emergency rooms without increasing the use of other high-risk medications. They found that the SHAPED (Sydney Health Partners Emergency Department) trial guideline training intervention reduced opioid dispensing by 12.3%.

In a research letter titled “Switching from opioids to simple analgesics for emergency care of patients with low back pain: a secondary analysis of the SHAPED cluster randomized trial,” published in the JAMA Health Forumthe team, from institutions including Laval University, the Royal Prince Alfred Hospital and the University of Sydney, suggests that SHAPED has been a success.

There is an ongoing debate about the use of opioids in clinical settings with the goal of reducing opioid exposure for patients with less critical needs. Clinical guidelines for lower back pain consistently recommend against the use of opioids, preferring nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol as first-line treatments.

Even with these guidelines in place, opioids are still widely prescribed in emergency departments to treat lower back pain. In Australia, almost two-thirds of patients with lower back pain receive opioids in emergency rooms, while in the United States the percentage is much lower, around 40% for similar patients.

The SHAPED trial was launched in response to this ongoing discrepancy, with the goal of aligning ED treatment practices with established guidelines by training interventions and promoting safer pain management strategies.

During the trial, opioid dispensing dropped from 62.8% to 50.5% for lower back pain cases, a significant decline. The study found no evidence that emergency department doctors replaced opioids with other potentially risky medications, such as benzodiazepines or antiepileptic drugs. Instead, the use of NSAIDs alone increased by 1.4% and the combination of NSAIDs with paracetamol increased by 7.1%.

Trial results also indicated a significant decrease in benzodiazepine use (by 2.3%), confirming the effectiveness of the guideline-based education intervention in promoting safer treatment options .

The SHAPED trial’s success in reducing opioid use without increasing the use of other high-risk medications marks a promising step toward safer pain management in emergency departments. The increased adoption of NSAIDs and acetaminophen aligns with global efforts to alleviate the opioid crisis and highlights the importance of adhering to evidence-based clinical guidelines.

The study authors highlighted the need for further research to determine the most effective strategies for expanding these interventions to other health care settings and countries.

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