Background: Tolerance to opioids among opium-dependent patients creates obstacles for
proper pain management of these patients in the emergency department (ED). The aim of the present
study was to investigate the efficacy of intramuscular (IM) haloperidol plus midazolam on morphine
analgesia among opium-dependent patients.
Methods: Opium-dependent adults who were admitted to the ED for new-onset severe pain in the
limbs or abdomen (within 24 hours of admission and a pain score of over six, using a numerical rating
scale [NRS]) were recruited. Participants were randomly assigned into two groups. Group A received
morphine 0.05 mg/kg intravenously (IV) and a mixture of midazolam 2.5 mg and haloperidol 2.5 mg
(diluted in 5 cc of distilled water, IM); group B received morphine 0.05 mg/kg IV and distilled water 5
cc, IM. Measured outcomes were related to: 1) pain intensity; 2) total doses of morphine; 3) changes in
hemodynamic status and level of consciousness of patients. NRS scores (zero to 10) before and one,
three and six hours following intervention, as well as total doses of morphine, were recorded.
Results: We recruited 68 males (78.16%) and 19 females (21.83%). The mean age was 38.28±6.59
years. The pain score in group A declined more rapidly over six hours than that in group B. Moreover,
as compared to group B, the amount of morphine use decreased significantly in group A.
Conclusion: Based on the present data, adding haloperidol plus midazolam to morphine for pain management
improved pain scores and lowered morphine consumption among opium-dependent patients.