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The Prescribing of Opioids to Emergency Patients for the Treatment of Pain: The Issues Continue

  • Pain Management in Adults (S. Mace, Section Editor)
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Abstract

Due to increased emphasis on pain and pain management and other contributing factors, there has been an enormous increase in the prescribing of opioids in medicine and emergency medicine over the past several years. Unfortunately, there has also been a subsequent rise in the untoward complications of opioid prescribing: increases in abuse, addiction, overdose, and death. In this report, we will investigate many of the issues surrounding the use of opioids and steps we, as practitioners, can take to avoid some of these problems while providing appropriate care to our patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Portenoy RK, Foley KM. Chronic use of opioid analgesics in nonmalignant pain: report of 38 cases. Pain. 1986;25:171–86.

    Article  CAS  PubMed  Google Scholar 

  2. The use of opioids for the treatment of chronic pain. A consensus statement from the American Academy of Pain Medicine and the American Pain Society. Clin J Pain. 1997;13:6–8.

  3. Pizzo PA, Clark NM. Alleviating suffering 101—pain relief in the United States. N Engl J Med. 2012;366:197–9.

    Article  CAS  PubMed  Google Scholar 

  4. Lanser P, Gesell S. Pain management: the fifth vital sign. Healthc Benchmarks. 2001;8(62):68–70.

    CAS  PubMed  Google Scholar 

  5. Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: National Academies Press; 2011.

    Google Scholar 

  6. Lembke A. Why doctors prescribe opioids to known opioid abusers. N Engl J Med. 2012;367:1580–1.

    Article  CAS  PubMed  Google Scholar 

  7. Bhakta HC, Marco CA. Pain management: association with patient satisfaction among emergency department patients. J Emerg Med. 2014;46:456–64.

    Article  PubMed  Google Scholar 

  8. Meier B. In guilty plea, OxyContin maker to pay $600 million. New York Times. 2007. http://www.nytimes.com/2007/05/10/business/11drug-web.html. Accessed 30 July 2015.

  9. Berger E. Orange County sues opioid drug makers. Ann Emerg Med. 2015;65(1):15A–7A.

    Article  Google Scholar 

  10. Catan T, Perez E. A pain-drug champion has second thoughts. Wall Str J. 2012. http://online.wsj.com/news/articles/SB10001424127887324478304578173342657044604. Accessed 30 July 2015.

  11. Von Korff M, Kolodny A, Deyo RA, et al. Long-term opioid therapy reconsidered. Ann Intern Med. 2011;155:325–8.

    Article  Google Scholar 

  12. Grady D, Berkowitz SA, Katz MH. Opioids for chronic pain. Arch Intern Med. 2011;171:1426–7.

    Article  PubMed  Google Scholar 

  13. Dhalla IA, Persaud N, Juurlink DN. Facing up to the prescription opioid crisis. BMJ. 2011;343:d5142.

    Article  PubMed  Google Scholar 

  14. Boscarino JA, Rukstalis MR, Hoffman SN, et al. Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the DSM-5 vs. DSM-4 diagnostic criteria. J Addict Dis. 2011;30:185–94.

    Article  PubMed  Google Scholar 

  15. Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf. 2006;15:618–27.

    Article  PubMed  Google Scholar 

  16. Paulozzi LJ, Jones CM, Mack KA, Centers for Disease Control and Prevention, et al. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999-2008. Morb Mortal Wkly Rep. 2011;60:1487–92.

    Google Scholar 

  17. Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11:S63–88.

    PubMed  Google Scholar 

  18. Muhuri PK, Gfroerer JC, Davies MC. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Rev. 2013. http://www.samhsa.gov/data/2k13/DataReview/DR006/nonmedical-pain-reliever-use-2013.htm. Accessed 30 July 2015.

  19. Jones CM, Logan J, Gladden RM, Centers for Disease Control and Prevention, et al. Vital signs: demographic and substance use trends among heroin user—United States, 2002-2013. Morb Mortal Wkly Rep. 2015;64:719–25.

    Google Scholar 

  20. Volkow ND, McLellan TA, Cotto JH. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305:1299–301.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Hansen GR. The drug-seeking patient in the emergency room. Emerg Med Clin N Am. 2005;23:349–65.

    Article  Google Scholar 

  22. Straube ST, Lopez JJ, Baird J, et al. Prescription opioid misuse is common among emergency department patients discharged with opioids (Abstract). Ann Emerg Med. 2013;62(4S):S92.

    Article  Google Scholar 

  23. Bitterman RA. Is “severe pain” considered an emergency medical condition under EMTALA? ACEP News. 2013;34(4). http://www.acepnow.com/article/severe-pain-considered-emergency-medical-condition-emtala/. Accessed 30 July 2015.

  24. Mazer-Amirshahi M, Nelson L, Pines J. West Virginia Supreme Court ruling allows physician liability for patient addiction. Emerg Physicians Mon. 2015. http://www.epmonthly.com/www.epmonthly.com/departments/subspecialties/medico-legal/you-re-suing-me-for-what/?utm_source=July+30th+Ezine&utm_campaign=EPM+August+27+2014&utm_medium=email. Accessed 24 July 2015.

  25. Office of National Drug Control Policy. Prescription drug abuse prevention plan. 2011. http://www.whitehouse.gov/sites/default/files/ondcp/issues-content/prescription-drugs/rx_abuse_plan.pdf. Accessed 30 July 2015.

  26. Wilsey BL, Fishman SM, Gilson AM, et al. Profiling multiple provider prescribing of opioids, benzodiazepines, stimulants, and anorectics. Drug Alcohol Depend. 2010;112:99–106.

    Article  CAS  PubMed  Google Scholar 

  27. Katz N, Panas L, Kim M, et al. Usefulness of prescription monitoring programs for surveillance—analysis of schedule II opioid prescription data in Massachusetts, 1996-2006. Pharmacoepidemiol Drug Saf. 2010;19:115–23.

    Article  PubMed  Google Scholar 

  28. Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008;300:2613–20.

    Article  CAS  PubMed  Google Scholar 

  29. • Pradel V, Frauger E, Thirion X, et al. Impact of a prescription monitoring program on doctor-shopping for high dose buprenorphine. Pharmacoepidemiol Drug Saf. 2009;18:36–43. These are 9 opioid prescribing recommendations, with explanation, developed for use in New York City.

  30. Haffajee RL, Jeba AB, Weiner SG. Mandatory use of prescription drug monitoring programs. JAMA. 2015;313:891–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Baehren DF, Marco CA, Droz DE, et al. A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2010;56:19–23.

    Article  PubMed  Google Scholar 

  32. Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med. 2013;62:281–9.

    Article  PubMed  Google Scholar 

  33. Reifler LM, Droz D, Bailey JE, et al. Do prescription monitoring programs impact state trends in opioid abuse/misuse? Pain Med. 2012;13:434–42.

    Article  PubMed  Google Scholar 

  34. Utah Department of Health. Utah clinical guidelines on prescribing opioids for treatment of pain. Salt Lake City. 2009. http://health.utah.gov/prescription/pdf/guidelines/final.04.09opioidGuidlines.pdf. Accessed 25 July 2015.

  35. • Washington Emergency Department Opioid Prescribing Guidelines. http://washingtonacep.org/postings/edopioidabuseguidelinesfinal.pdf. Accessed 29 July 2015. These are the 17 opioid prescribing recommendations developed by Washington ACEP along with 3 other groups that have been adopted state-wide. Background and a detailed explanation of each recommendation is provided.

  36. Oregon ACEP. Oregon emergency department (ED) opioid prescribing guidelines. http://www.ocep.org/images/pdf/ed_opioid_abuse_guidelines.pdf. Accessed 29 July 2015.

  37. Ohio Emergency and Acute Care Facility Opioids and Other Controlled Substances (OOCS) Prescribing Guidelines. http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Files/edguidelines/EGs%20no%20poster.ashx. Accessed 29 July 2015.

  38. New York City Emergency Department Discharge Opioid Prescribing Guidelines. http://www.nyc.gov/html/doh/downloads/pdf/basas/opioid-prescribing-guidelines.pdf. Accessed July 29, 2015.

  39. Poon SJ, Greenwood-Ericksen MB. The opioid prescription epidemic and the role of emergency medicine. Ann Emerg Med. 2014;64:490–5.

    Article  PubMed  Google Scholar 

  40. •• Cantrill SV, Brown MD, Carlisle RJ, et al. Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012;60:499–525. This is a clinical policy (guideline) developed by the American College of Emergency Physicians which deals with 4 critical questions regarding opioid prescribing for emergency patients as outlined above. To the degree possible, this is an evidenced based document.

  41. Passik SD, Kirsh KL, Casper D. Addiction-related assessment tools and pain management: instruments for screening, treatment planning, and monitoring compliance. Pain Med. 2008;9(suppl 2):S145–66.

    Article  Google Scholar 

  42. Weiner SG, Horton LC, Green TC, et al. Feasibility of tablet computer screening for opioid abuse in the emergency department. West J Emerg Med. 2015;16(1):18–23.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chang AK, Bijur PE, Lupow JB, et al. Comparative analgesic efficacy of oxycodone/acetaminophen vs codeine/ccetaminophen for short-term pain management following ED discharge. Pain Med. 2015;. doi:10.1111/pme.12830.

    Google Scholar 

  44. Weiner SG. Emergency medicine and the opioid epidemic. ACEP Now. 2015;34(7):6–7.

    Google Scholar 

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Authors and Affiliations

  1. Denver Health, 777 Bannock St., MC 8800, Denver, CO, 80204-4507, USA

    Stephen V. Cantrill

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  1. Stephen V. Cantrill
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Correspondence to Stephen V. Cantrill.

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This article is part of the Topical Collection on Pain Management in Adults.

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Cantrill, S.V. The Prescribing of Opioids to Emergency Patients for the Treatment of Pain: The Issues Continue. Curr Emerg Hosp Med Rep 4, 40–45 (2016). https://doi.org/10.1007/s40138-016-0098-x

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  • DOI: https://doi.org/10.1007/s40138-016-0098-x

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