Objective Individual experience with opioids is highly variable. Some patients with acute pain do not experience pain relief with opioids, and many report no euphoria or dysphoric reactions. In this study, we describe the clinical phenotypes of patients who receive intravenous opioids.
Methods This was an emergency department-based study in which we enrolled patients who received an intravenous opioid. We collected 0 to 10 pain scores prior to opioid administration and 15 minutes after. We also used 0 to 10 instruments to determine how high and how much euphoria the patient felt after receipt of the opioid. Using a cutoff point of ≥50% improvement in pain and the median score on the high and euphoria scales, we assigned each participant to one of the following clinical phenotypes: pain relief with feeling high or euphoria, pain relief without feeling high or euphoria, inadequate relief with feeling high or euphoria, and inadequate relief without feeling high or euphoria.
Results A total of 713 patients were enrolled, 409 (57%) of whom reported not feeling high, and 465 (65%) reported no feeling of euphoria. Median percent improvement in pain was 37.5% (interquartile range, 12.5%–60.0%). One hundred seventy-eight participants (25%) were classified as experiencing pain relief with euphoria or feeling high, 190 (27%) experienced inadequate relief with euphoria or feeling high, 101 (14%) experienced pain relief without euphoria or feeling high, and 244 (34%) reported inadequate relief without euphoria or feeling high.
Conclusion Among patients who receive intravenous opioids in the emergency department, the experiences of pain relief and euphoria are highly variable. For many, pain relief is independent of feeling high.
Citations
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Association of acute opioid-induced euphoria and analgesia with subsequent opioid prescriptions in an emergency department–based prospective cohort study Spencer Brown, Eddie Irizarry, Andrew Williams, Michelle Davitt, Jesse Baer, Benjamin W. Friedman Clinical and Experimental Emergency Medicine.2026; 13(2): 207. CrossRef
A Prospective Cohort Study to Determine Which Opioid-Naïve Emergency Department Patients Are at Risk of Persistent Opioid Use Lorena Abril, Lauren Gilbert, Fernanda Pacheco, Mai Takematsu, Michelle Davitt, Kristen Schimmrich, Jesse Baer, Gregory Mazarin, Chiraag Gupta, Victoria Adewunmi, Eddie Irizarry, Benjamin W. Friedman Annals of Emergency Medicine.2025; 86(2): 179. CrossRef
The burden of acute pain in the U.S. in the wake of the opioid crisis James C. Hackworth, John E. Schneider, Maggie Do Valle, David Fam, Charles Argoff, Emanuela Offidani, Jim Potenziano Frontiers in Pain Research.2025;[Epub] CrossRef
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Objective To study the effect of time on shift on the opioid prescribing practices of emergency physicians among patients without chronic opioid use.
Methods We analyzed pain-related visits for five painful conditions from 2010 to 2017 at a single academic hospital in Boston. Visits were categorized according to national guidelines as conditions for which opioids are “sometimes indicated” (fracture and renal colic) or “usually not indicated” (headache, low back pain, and fibromyalgia). Using conditional logistic regression with fixed effects for clinicians, we estimated the probability of opioid prescribing for pain-related visits as a function of shift hour at discharge, time of day, and patient-level confounders (age, sex, and pain score).
Results Among 16,115 visits for which opioids were sometimes indicated, opioid prescribing increased over the course of a shift (28% in the first hour compared with 40% in the last hour; adjusted odds ratio, 1.06; 95% confidence interval, 1.02–1.10; adjusted P-trend <0.01). However, among visits for which opioids are usually not indicated, relative to the first hour, opioid prescriptions progressively fell (40% in the first hour compared with 23% in the last hour; adjusted odds ratio, 0.93; 95% confidence interval, 0.91–0.96; adjusted P-trend <0.01).
Conclusion As shift hour progressed, emergency physicians became more likely to prescribe opioids for conditions that are sometimes indicated, and less likely to prescribe opioids for nonindicated conditions. Our study suggests that clinical decision making in the emergency department can be substantially influenced by external factors such as clinician shift hour.
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Systematic review of the effects of decision fatigue in healthcare professionals on medical decision-making Mona Maier, Daniel Powell, Peter Murchie, Julia L. Allan Health Psychology Review.2025; 19(4): 717. CrossRef
Assessing Decision Fatigue in General Practitioners’ Prescribing Decisions Using the Australian BEACH Data Set Mona Maier, Daniel Powell, Christopher Harrison, Julie Gordon, Peter Murchie, Julia L. Allan Medical Decision Making.2024; 44(6): 627. CrossRef
Examining the effects of physician burnout on pain management for patients with advanced lung cancer Veronica Derricks, Izzy Gainsburg, Cleveland Shields, Kevin Fiscella, Ronald Epstein, Veronica Yu, Jennifer J. Griggs Supportive Care in Cancer.2023;[Epub] CrossRef
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