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Antivenom Treatment Is Associated with Fewer Patients using Opioids after Copperhead Envenomation.
West J Emerg Med. 2019 May; 20(3):497-505.WJ

Abstract

Introduction

Copperhead envenomation causes local tissue destruction, leading people to seek treatment for the pain and swelling. First-line treatment for the pain is opioid medications. There is rising concern that an initial opioid prescription from the emergency department (ED) can lead to long-term addiction. This analysis sought to determine whether use of Fab antivenom (FabAV) for copperhead envenomation affected opioid use.

Methods

We performed a secondary analysis using data from a randomized clinical trial designed to determine the effect of FabAV on limb injury recovery following mild to moderate copperhead envenomation. Opioid use was a defined secondary outcome in the parent trial. Patients were contacted after discharge, and data were obtained regarding medications used for pain and the patients' functional status. This analysis describes the proportion of patients in each treatment group reporting opioid use at each time point. It also assesses the interaction between functional status and use of opioids.

Results

We enrolled 74 patients in the parent trial (45 received FabAV, 29 placebo), of whom 72 were included in this secondary analysis. Thirty-five reported use of any opioids after hospital discharge. A smaller proportion of patients treated with FabAV reported opioid use: 40.9% vs 60.7% of those in the placebo group. The proportion of patients using opioids remained smaller in the FabAV group at each follow-up time point. Controlling for confounders and interactions between variables, the model estimated that the odds ratio of using opioids after hospital discharge among those who received placebo was 5.67 times that of those who received FabAV. Patients who reported higher baseline pain, those with moderate as opposed to mild envenomation, and females were more likely to report opioid use at follow-up. Patients with ongoing limitations to functional status had an increased probability of opioid use, with a stronger association over time. Opioid use corresponded with the trial's predefined criteria for full recovery, with only two patients reporting opioid use in the 24 hours prior to achieving full limb recovery and no patients in either group reporting opioid use after full limb recovery.

Conclusion

In this study population, the proportion of patients using opioids for pain related to envenomation was smaller in the FabAV treatment group at all follow-up time points.

Authors+Show Affiliations

Duke University, Division of Emergency Medicine, Durham, North Carolina.Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, Colorado.Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, Colorado.University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas.University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas.Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, Colorado.Duke University, Division of Emergency Medicine, Durham, North Carolina.No affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31123552

Citation

Freiermuth, Caroline E., et al. "Antivenom Treatment Is Associated With Fewer Patients Using Opioids After Copperhead Envenomation." The Western Journal of Emergency Medicine, vol. 20, no. 3, 2019, pp. 497-505.
Freiermuth CE, Lavonas EJ, Anderson VE, et al. Antivenom Treatment Is Associated with Fewer Patients using Opioids after Copperhead Envenomation. West J Emerg Med. 2019;20(3):497-505.
Freiermuth, C. E., Lavonas, E. J., Anderson, V. E., Kleinschmidt, K. C., Sharma, K., Rapp-Olsson, M., & Gerardo, C. (2019). Antivenom Treatment Is Associated with Fewer Patients using Opioids after Copperhead Envenomation. The Western Journal of Emergency Medicine, 20(3), 497-505. https://doi.org/10.5811/westjem.2019.3.42693
Freiermuth CE, et al. Antivenom Treatment Is Associated With Fewer Patients Using Opioids After Copperhead Envenomation. West J Emerg Med. 2019;20(3):497-505. PubMed PMID: 31123552.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antivenom Treatment Is Associated with Fewer Patients using Opioids after Copperhead Envenomation. AU - Freiermuth,Caroline E, AU - Lavonas,Eric J, AU - Anderson,Victoria E, AU - Kleinschmidt,Kurt C, AU - Sharma,Kapil, AU - Rapp-Olsson,Malin, AU - Gerardo,Charles, AU - ,, Y1 - 2019/04/26/ PY - 2019/02/07/received PY - 2019/03/29/revised PY - 2019/03/20/accepted PY - 2019/5/25/entrez PY - 2019/5/28/pubmed PY - 2019/11/30/medline SP - 497 EP - 505 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 20 IS - 3 N2 - Introduction: Copperhead envenomation causes local tissue destruction, leading people to seek treatment for the pain and swelling. First-line treatment for the pain is opioid medications. There is rising concern that an initial opioid prescription from the emergency department (ED) can lead to long-term addiction. This analysis sought to determine whether use of Fab antivenom (FabAV) for copperhead envenomation affected opioid use. Methods: We performed a secondary analysis using data from a randomized clinical trial designed to determine the effect of FabAV on limb injury recovery following mild to moderate copperhead envenomation. Opioid use was a defined secondary outcome in the parent trial. Patients were contacted after discharge, and data were obtained regarding medications used for pain and the patients' functional status. This analysis describes the proportion of patients in each treatment group reporting opioid use at each time point. It also assesses the interaction between functional status and use of opioids. Results: We enrolled 74 patients in the parent trial (45 received FabAV, 29 placebo), of whom 72 were included in this secondary analysis. Thirty-five reported use of any opioids after hospital discharge. A smaller proportion of patients treated with FabAV reported opioid use: 40.9% vs 60.7% of those in the placebo group. The proportion of patients using opioids remained smaller in the FabAV group at each follow-up time point. Controlling for confounders and interactions between variables, the model estimated that the odds ratio of using opioids after hospital discharge among those who received placebo was 5.67 times that of those who received FabAV. Patients who reported higher baseline pain, those with moderate as opposed to mild envenomation, and females were more likely to report opioid use at follow-up. Patients with ongoing limitations to functional status had an increased probability of opioid use, with a stronger association over time. Opioid use corresponded with the trial's predefined criteria for full recovery, with only two patients reporting opioid use in the 24 hours prior to achieving full limb recovery and no patients in either group reporting opioid use after full limb recovery. Conclusion: In this study population, the proportion of patients using opioids for pain related to envenomation was smaller in the FabAV treatment group at all follow-up time points. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/31123552/Antivenom_Treatment_Is_Associated_with_Fewer_Patients_using_Opioids_after_Copperhead_Envenomation L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31123552/ DB - PRIME DP - Unbound Medicine ER -