Last updated January 13, 2022

Prescribing of Opioids for Adult Patients in the Emergency Department

Patient Management

When possible, treat opioid withdrawal in the ED with buprenorphine or methadone as a more effective option compared with nonopioid-based management strategies such as the combination of α2-adrenergic agonists and antiemetics. (B)
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Preferentially treat opioid withdrawal in the ED with buprenorphine rather than methadone. (C)
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Preferentially prescribe nonopioid analgesic therapies (nonpharmacologic and pharmacologic) rather than opioids as the initial treatment of acute pain in patients discharged from the ED.
For cases in which opioid medications are deemed necessary, prescribe the lowest effective dose of a shortacting opioid for the shortest time indicated. (C)
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Do not routinely prescribe opioids to treat an acute exacerbation of noncancer chronic pain for patients discharged from the ED. Nonopioid analgesic therapies (nonpharmacologic and pharmacologic) should be used preferentially. For cases in which opioid medications are deemed appropriate, prescribe the lowest indicated dose of a shortacting opioid for the shortest time that is feasible. (C)
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Do not routinely prescribe, or knowingly cause to be co-prescribed, a simultaneous course of opioids and benzodiazepines (as well as other muscle relaxants/sedative-hypnotics) for treatment of an acute episode of pain in patients discharged from the ED. (C)
(Consensus recommendation)
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Recommendation Grading

Overview

Title

Prescribing of Opioids for Adult Patients in the Emergency Department

Authoring Organization

Publication Month/Year

October 1, 2012

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This clinical policy deals with critical issues in prescribing of opioids for adult patients treated in the emergency department (ED)

Target Patient Population

Patients with acute non-cancer pain/exacerbation of chronic pain

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Emergency care

Intended Users

Paramedic emt

Scope

Assessment and screening, Management, Treatment

Diseases/Conditions (MeSH)

D059350 - Chronic Pain, D059408 - Pain Management, D010146 - Pain, D059787 - Acute Pain

Keywords

opioids, acute pain, noncancer pain

Source Citation

Ann Emerg Med. 2012;60:499-525.