Experiences and perspectives of patients visiting Dutch emergency departments on opioid (mis)use: a qualitative interview study

Background and importance The increase in opioid prescribing and opioid-related harm is a public health concern in many Western countries. Physicians in the emergency department (ED) frequently prescribe opioids for acute pain and play a role in the acute management of opioid-related harm. Yet, patient perspectives on the role of the ED in opioid management remain largely unexplored. Objective This study aimed to explore how patients discharged from Dutch EDs with a new opioid prescription perceive ED opioid prescribing, the information and guidance they receive and the potential for opioid-related harm to inform safer opioid management in the ED. Design A qualitative interview study using semi-structured interviews. Settings and participants The study was conducted at two EDs in the Netherlands: Leiden University Medical Center (academic hospital) and Haaglanden Medical Center (teaching hospital). Adult patients (≥18 years) discharged from the ED with a new opioid prescription were recruited through purposive sampling. Patients (n=35) were interviewed either by telephone after discharge (n=28) or in person at the ED directly after discharge (n=7). Outcome measures and analysis Thematic analysis was performed to develop key themes reflecting patients9 experiences and perspectives towards opioid use and potential misuse, in relation to an ED visit. Results Three themes were developed from 35 interviews, encompassing: (1) Opioid prescribing practices at the ED; where patients described variable prescribing behaviours, limited information and lack of structured follow-up, (2) Navigating pain and dilemmas in opioid use; reflecting how acute pain drove opioid use despite concerns about side effects and stigma, (3) The perceived risk of opioid addiction after an ED visit; where patients acknowledged risks but often considered themselves protected by resilience, self-regulation and social support. Conclusion These findings show that while ED patients trust physicians’ prescribing, insufficient communication and aftercare leave them uncertain about safe opioid use and tapering. Implementing standardised, patient-centred discharge instructions and follow-up could strengthen safe opioid-prescribing practices at the ED, support patients in managing acute pain and may help to reduce the risk of long-term opioid-related harm.