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Opioid Prescribing in the ED

Opioid Prescribing in the ED

Many patients seeking care in the emergency department (ED) present with severe pain, which may be due to an acute or chronic condition. A primary goal of emergency care is to alleviate pain quickly, safely, effectively, and compassionately. Opioid medications remain the mainstay for treatment of severe pain.

However, the tragic results of misuse and abuse of opioids are seen all too frequently in the ED. The number of deaths related to the misuse and abuse of opioid medications has reached what has been called epidemic proportions. Federal and state government agencies, healthcare institutions, and practitioners have all worked to develop a variety of solutions to this problem. Prescription drug monitoring programs (PDMPs),better patient assessment tools, prescribing guidelines (or rules), patient educational materials, pain contracts or care plans, and freer access to naloxone have all been used in an effort to curb deaths from opioid abuse.

Treatment of chronic pain with long-acting opioid medications is a primary driver of the opioid epidemic, made worse by the aging population. Misuse and diversion of these medications is a serious problem, but significant numbers of these agents are rarely prescribed from the ED.

It is important for emergency physicians to understand that while they are not the primary cause of the opioid abuse epidemic, they do have a role to play in fighting it. Because of the patient population they treat, emergency physicians are frequent prescribers of opioids, and thus may become targets for over-zealous regulators.

It is incumbent upon emergency physicians to be active participants in the quest for solutions, to always remain a strong advocate for their patients, and to adapt their practices to this new societal reality.

  • With better assessment tools, we can identify patients at risk for substance abuse.
  • By using PDMPs, we can identify patients that might be doctor shopping.
  • By using reasonable prescribing guidelines, we can limit the number of opioids in society, while adequately addressing the legitimate pain relief needs of our patients.
  • With better educational tools, we can help patients understand the proper use (and potential for misuse or diversion) of these medications.
  • Facilities that use care plans and pain contracts and that have treatment facilities can improve patient care.

Patient education regarding opioids can be a sensitive issue and must occur only after the patient is assessed. Posters in the waiting room are to be avoided because they could be perceived as discouraging patients from seeking emergency care. It is important to educate patients on this subject, but only after they have received a medical screening examination consistent with the Emergency Medical Treatment & Labor Act (EMTALA) regulations.

The resources contained in this document were compiled to provide background information, educational resources, patient handouts, and case management materials regarding opioid prescribing in the ED, with an emphasis on EMTALA-compliant patient education materials.

 

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