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Comment & Response
July 9, 2019

Limiting Opioid Prescribing

Author Affiliations
  • 1OPUM (Quantity of Opioids for Acute Pain and Unused Medication) Project, Montreal, Quebec, Canada
JAMA. 2019;322(2):170-171. doi:10.1001/jama.2019.5844

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.