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Jun 23rd, 12

ACEP Issues Clinical Policy on Opioid Prescribing for Patients Presenting to the Emergency Department

Deaths due to prescription opioids are a significant problem, accounting for nearly 15,000 fatalities in 2008 (a more than threefold increase compared to 10 years previously).  In fact, deaths due to drug overdoses are second only to motor vehicle crashes as a cause of injury-related deaths.  The American College of Emergency Physicians (ACEP) has recognized that this is an issue of significant public health concern and has issued a new policy addressing issues with prescribing opioids to patients presenting to the emergency department (ED).  Among the highlights:

  • The use of a state prescription monitoring program may help identify patients who are at high risk for prescription opioid diversion or doctor shopping.
  • Emergency physicians should determine whether nonopioid analgesics (i.e., acetaminophen or NSAIDs) may be adequate for initial pain management.
  • Given the risks associated with opioid use, misuse, and abuse, opioids should be reserved for more severe pain or pain refractory to other analgesics rather than routinely prescribed.
  • If opioids are indicated, the prescription should be for the lowest practical dose for a limited duration (e.g., <1 week), and the prescriber should consider the patient’s risk for opioid misuse, abuse, or diversion.
  • Physicians should avoid routinely prescribing outpatient opioids for a patient with an acute exacerbation of chronic noncancer pain seen in the ED.
  • ED physicians should attempt to honor existing patient-physician pain contracts/treatment agreements and consider past prescription patterns from information sources such as prescription drug monitoring programs.

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