Researchers in Australia have completed a review of a trial focused on reducing opioid dispensing in emergency room settings without increasing reliance on other high-risk medications. They found that the SHAPED (Sydney Health Partners Emergency Department) trial’s guideline training intervention reduced opioid dispensing by 12.3%.

In a research letter titled “Shifting From Opioids to Simple Analgesics for Emergency Care of Patients With Low Back Pain: A Secondary Analysis of the SHAPED Cluster Randomized Trial,” published in the JAMA Health Forumthe team—from institutions including Laval University, Royal Prince Alfred Hospital, and the University of Sydney—suggests that SHAPED was a success.

There is an ongoing conversation about opioid use in clinical settings in an effort to reduce exposure to opioids for patients in less critical need. Clinical guidelines for lower back pain consistently recommend against the use of opioids, instead advising nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol as first-line treatments.

Even with these guidelines in place, opioids are still widely prescribed in emergency room departments for lower back pain. In Australia, nearly two-thirds of lower back pain patients receive opioids in emergency rooms, whereas in the United States the percentage is much lower, at around 40% for similar patients.

The SHAPED trial was launched in response to this ongoing discrepancy, aiming to align emergency room treatment practices with established guidelines by training interventions and promoting safer pain management strategies.

Over the course of the trial, opioid dispensing dropped from 62.8% to 50.5% for lower back pain cases, a significant decline. The study found no evidence that emergency department physicians substituted opioids with other potentially risky medications, such as benzodiazepines or antiepileptics. Instead, the use of NSAIDs alone increased by 1.4%, and the combination of NSAIDs with paracetamol rose by 7.1%.

The trial’s findings also indicated a significant decrease in the use of benzodiazepines—by 2.3%—further supporting the effectiveness of the guideline-based training intervention in promoting safer treatment options.

The SHAPED trial’s success in reducing opioid use without increasing reliance on other high-risk medications marks a promising step toward safer pain management in emergency departments. The increased adoption of NSAIDs and paracetamol aligns with global efforts to mitigate the opioid crisis and underscores the importance of adhering to evidence-based clinical guidelines.

The study authors highlighted the need for further research to determine the most effective strategies for scaling these interventions to other health care settings and countries.

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