To the Editor The Viewpoint by Dr Chua and colleagues1 discussed opioid prescribing limits for treatment of acute pain. I agree that uniform limits based on 5- or 7-day supplies are problematic. For a 5-day supply, up to 60 pills can be prescribed. However, a previous study reported that opioid consumption during the first 2 weeks after an emergency department visit for acute pain was a median of seven 5-mg morphine pills (or equivalent).2 To adequately supply 80% of patients, the study estimated that 30 pills would be sufficient for patients with fractures, 15 for those with renal colic, and 20 for those with other conditions. With the proposed 5-day supply of 60 pills, many patients will have in their possession a significant number of residual opioid pills available for misuse. Moreover, co-analgesic use should be optimized. Most US studies use combinations of opioids and acetaminophen, which prevents many patients from adequately optimizing their daily acetaminophen dosage.
Daoust R. Limiting Opioid Prescribing. JAMA. 2019;322(2):170–171. doi:10.1001/jama.2019.5844
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