Oxycodone induced euphoria in ED patients with acute musculoskeletal pain. A secondary analysis of data from a randomized trial

Objectives: Some opioid-naïve patients with acute musculoskeletal pain who are treated with opioids develop persistent opioid use. The impact of opioid-induced euphoria on this transition to persistent use has not been explored. We determined whether opioid-induced euphoria could be measured as a phenomenon distinct from relief of pain. Methods: Patients with acute pain were randomized to receive oxycodone/acetaminophen (Oxy) or acetaminophen (APAP). We measured pain using a 0–10 verbal scale. To assess euphoria, participants provided a 0–10 response to each of these: 1) How good did the medication make you feel?; 2) How high did the medication make you feel?; 3) How blissful did the medication make you feel? We analyzed these data using successive multivariable linear regression models, in which each of these items was the dependent variable, and improvement in pain and medication were the independent variables, while controlling for age and sex. Results: 75 were randomized to Oxy, 76 to APAP. Mean “how good” scores were 6.3 (SD 3.3) in the Oxy group and 4.8 (3.3) in the APAP group. Mean “how high” scores were 3.8 (3.7) in the Oxy group and 2.0 (3.0) in the APAP group. Mean “how blissful” scores were 4.9 (3.7) in the Oxy group and 3.1 (3.4) in the APAP group. After controlling for improvement in pain, age, and sex, the between-group difference in “how good” was 1.0 (95%CI: −0.1, 2.0), “how high” 1.5 (95% CI 0.4, 2.6), and “how blissful” 1.5 (95%CI: 0.4, 2.7). Discussion: “How high” and “how blissful” but not “how good” were associated with opioid use after controlling for improvement in pain.