{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T23:33:49Z","timestamp":1784763229007,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,4,2]],"date-time":"2023-04-02T00:00:00Z","timestamp":1680393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of randomized controlled trial participants followed prospectively for 90\u2009days after an emergency department (ED) visit for acute back or kidney stone pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 1301 individuals were randomized during an encounter at four academic EDs into a probabilistic risk tool (PRT) arm, a narrative\u2010enhanced PRT arm, or a general risk information arm (control). In this secondary analysis, both risk tool arms were combined and compared with the control arm. We used logistic regressions to determine associations between receiving personalized risk information, receiving an opioid prescription in the ED, and nonprescribed opioid use in general and by race.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Complete follow\u2010up data were available for 851 participants; 23.3% (<jats:italic>n<\/jats:italic>\u00a0=\u2009198) were prescribed opioids (34.2% of White vs. 11.6% of Black participants, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001). Fifty\u2010six (6.6%) participants used nonprescribed opioids. Participants in the personalized risk communication arms had lower nonprescribed opioid use odds (adjusted odds ratio [aOR] 0.58, 95% confidence interval [CI] 0.4\u20130.83). Black versus White participants had greater nonprescribed opioid use odds (aOR 3.47, 95% CI 2.05\u20135.87, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001). Black participants who were prescribed opioids had a lower marginal probability of using nonprescribed opioids versus those who were not (0.06, 95% CI 0.04\u20130.08, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001 vs. 0.10, 95% CI 0.08\u20130.11, <jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.001). The absolute risk difference in nonprescribed opioid use for Black and White participants, respectively, in the risk communication versus the control arm, was 9.7% and 0.1% (relative risk ratio 0.43 vs. 0.95).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among Black but not White participants, personalized opioid risk communication and opioid prescribing were associated with lower odds of nonprescribed opioid use. Our findings suggest that racial disparities in opioid prescribing\u2014which have been previously described within the context of this trial\u2014may paradoxically increase nonprescribed opioid use. Personalized risk communication may effectively reduce nonprescribed opioid use, and future research should be designed specifically to explore this possibility in a larger cohort.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14710","type":"journal-article","created":{"date-parts":[[2023,3,4]],"date-time":"2023-03-04T08:16:29Z","timestamp":1677917789000},"page":"851-858","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Personalized risk communication and opioid prescribing in association with nonprescribed opioid use: A secondary analysis of a randomized controlled trial"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-8926","authenticated-orcid":false,"given":"Max Jordan","family":"Nguemeni Tiako","sequence":"first","affiliation":[{"name":"Department of Medicine Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts 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Emergency Medicine, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin V.","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Zucker School of Medicine at Hofstra\/Northwell  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik P.","family":"Hess","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University School of Medicine  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh R.","family":"Bellamkonda","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic Alix School of Medicine, Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanmarie","family":"Perrone","sequence":"additional","affiliation":[{"name":"Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Center for Addiction Medicine and Policy University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn C.","family":"Cannuscio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Zucker School of Medicine at Hofstra\/Northwell  New York New York USA"},{"name":"Center for Public Health Initiatives University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Family Medicine and Community Health University of Pennsylvania  Philadelphia Pennsylvania 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