Abstract
Objective
Previous research demonstrated that administration of Morphine Sulfate Immediate Release
(MSIR) results in similar analgesic efficacy to Oxycodone but with significantly lesser
degrees of euphoria and reward. The purpose of this study sit to investigate if MSIR
combined with Acetaminophen can serve as an opioid analgesic alternative to Oxycodone
combined with acetaminophen (Percocet) for acute pain in the Emergency Department
(ED).
Methods
A prospective, randomized, double-blind trial of ED patients aged 18 to 64 years presenting
with moderate to severe acute pain as defined by an 11-point numeric rating scale
(NRS) with an initial score of ≥5 (0 = no pain and 10 = very severe pain). Patients
were randomized to receive either 15 mg MSIR combined with 650 mg of Acetaminophen
or 10 mg Oxycodone combined with 650 mg Acetaminophen. Patients were assessed at baseline,
30, 45 and 60 min. The primary outcome was reduction in pain at 60 min. Secondary
outcomes include drug likeability and adverse events.
Results
80 patients were enrolled in the study (40 per group). Demographic characteristics
were similar between the groups (P > 0.05). Mean NRS pain scores at baseline were 8.44 for the MSIR group and 8.53 for
the Percocet group (P = 0.788). Mean pain scores decreased over time but remained similar between the groups:
30 min (6.03 vs. 6.43; P = 0.453), 45 min (5.31 vs. 5.48; P = 0.779), and 60 min (4.22 vs. 4.87; P = 0.346). Reduction in mean NRS pain scores were statistically significant from baseline
to 30, 45 and 60 min within each group (P < 0.0001 at each time point for both groups). The largest NRS mean difference was
from baseline to 60 min: 4.2 (95% CI: 3.43 to 5.01) for MSIR group and 3.61 (95% CI:
2.79 to 4.43) for Percocet group. No clinically significant changes or any serious
adverse events were observed in either group.
Conclusion
MSIR provides similar analgesic efficacy as Percocet for short-term pain relief in
the ED, similar rates of nausea/vomiting, and lower rates of likeability of the drug.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Annual Surveillance Report of Drug Related Risks and Outcomes-United States.centers for Disease Control and Prevention, U.S. Department of Health and Human Service;2018, Atlanta, GA2018
- Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017.MMWR. Morbidity and mortality weekly report. 2018; 67
- Emergency Department Contribution to the Prescription Opioid Epidemic.Ann Emerg Med. 2018; 71 (659–667.e3)https://doi.org/10.1016/j.annemergmed.2017.12.007
- Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use.Ann Emerg Med. 2018; 71 (326–336.e19)https://doi.org/10.1016/j.annemergmed.2017.08.042
- Association of emergency department opioid initiation with recurrent opioid use.Ann Emerg Med. 2015; 65 (493–499.e4)https://doi.org/10.1016/j.annemergmed.2014.11.015
- The treatment of acute pain in the emergency department: a white paper position statement prepared for the American Academy of emergency medicine.J Emerg Med. 2018; 54: 731-736https://doi.org/10.1016/j.jemermed.2018.01.020
- Optimizing the Treatment of Acute Pain in the Emergency Department.Ann Emerg Med. 2017; 70: 446-448https://doi.org/10.1016/j.annemergmed.2017.06.043
- Temporal Factors Associated With Opioid Prescriptions for Patients With Pain Conditions in an Urban Emergency Department.JAMA Netw Open. 2020; 3 (Published 2020 Mar 2): e200802
- Involvement of the pyrilamine transporter, a putative organic cation transporter, in blood–brain barrier transport of oxycodone.Drug Metab Dispos. 2008; 36: 2005-2013
- The opioid epidemic: a central role for the blood brain barrier in opioid analgesia and abuse.Fluids Barriers CNS. 2017 Nov 29; 14: 32
- Rapid dopamine transmission within the nucleus accumbens: dramatic difference between morphine and oxycodone delivery.Eur J Neurosci. 2014; 40: 3041-3054
- Blood–brain barrier transport helps to explain discrepancies in in vivo potency between oxycodone and morphine.Anesthesiology. 2008; 108: 495-505
- In vivo blood–brain barrier transport of oxycodone in the rat: indications for active influx and implications for pharmacokinetics/pharmacodynamics.Drug Metab Dispos. 2006; 34: 1624-1631
- Likeability and abuse liability of commonly prescribed opioids.J Med Toxicol. 2012; 8: 335-340
- The abuse potential of prescription opioids in humans-closing in on the first century of research.Curr Top Behav Neurosci. 2017; 34: 33-58https://doi.org/10.1007/7854_2016_448
- Intravenous oxycodone, hydrocodone, and morphine in recreational opioid users: abuse potential and relative potencies.Psychopharmacology (Berl). 2010; 212: 193-203
- The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers.Drug Alcohol Depend. 2008; 98: 191-202https://doi.org/10.1016/j.drugalcdep.2008.05.007
- Consort.(Available at)
- (Accessed on 9/15/2020)
- The relative abuse liability of oral oxycodone, hydrocodone and hydromorphone assessed in prescription opioid abusers.Drug Alcohol Depend. 2008; 98: 191-202https://doi.org/10.1016/j.drugalcdep.2008.05.007
- Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers [published correction appears in Psychopharmacology (Berl). 2008 Jan;196(1):117].Psychopharmacology (Berl). 2008; 196: 105-116https://doi.org/10.1007/s00213-007-0937-2
- Oxycodone’s unparalleled addictive potential: is it time for a moratorium?.Curr Pain Headache Rep. 2019; 23: 15
- Determinants of fentanyl and other potent μ opioid agonist misuse in opioid-dependent individuals.Pharmacoepidemiol Drug Saf. 2010; 19: 1057-1063
- Within-subject comparison of the psychopharmacological profiles of oral hydrocodone and oxycodone combination products in non-drug-abusing volunteers.Drug Alcohol Depend. 2009; 101: 107-114
- Characterizing the subjective, psychomotor, and physiological effects of oral oxycodone in non-drug-abusing volunteers.Psychopharmacology. 2003; 170: 242-254
- Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers.Psychopharmacology. 2008; 196: 105-116
- Relative preferences in the abuse of immediate-release versus extended-release opioids in a sample of treatment-seeking opioid abusers.Pharmacoepidemiol Drug Saf. 2017; 26: 56-62
Article Info
Publication History
Published online: November 19, 2020
Accepted:
November 15,
2020
Received:
November 3,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2020 Elsevier Inc. All rights reserved.