Critical Issues in the Prescribing of Opiods for Adult Patients in the Emergency Department

Publication Date: June 1, 2020
Last Updated: March 14, 2022

Recommendations

The use of a state prescription monitoring program may help identify patients who are at high risk for prescription opioid diversion or doctor shopping. (C)
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(1) For the patient being discharged from the ED with acute low back pain, the emergency physician should ascertain whether nonopioid analgesics and nonpharmacologic therapies will be adequate for initial pain management.
(2) Given a lack of demonstrated evidence of superior efficacy of either opioid or nonopioid analgesics and the individual and community 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.
(3) If opioids are indicated, the prescription should be for the lowest practical dose for a limited duration (eg, 1 week), and the prescriber should consider the patient’s risk for opioid misuse, abuse, or diversion.
(C)
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For the short-term relief of acute musculoskeletal pain, emergency physicians may prescribe short-acting opioids such as oxycodone or hydrocodone products while considering the benefits and risks for the individual patient. (B)
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Research evidence to support superior pain relief for short-acting schedule II over schedule III opioids is inadequate. (C)
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(1) Physicians should avoid the routine prescribing of outpatient opioids for a patient with an acute exacerbation of chronic noncancer pain seen in the ED.
(2) If opioids are prescribed on discharge, the prescription should be for the lowest practical dose for a limited duration (eg, 1 week), and the prescriber should consider the patient’s risk for opioid misuse, abuse, or diversion.
(3) The clinician should, if practicable, honor existing patient-physician pain contracts/treatment agreements and consider past prescription patterns from information sources such as prescription drug monitoring programs. (C)
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Recommendation Grading

Overview

Title

Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

Authoring Organization

Publication Month/Year

June 1, 2020

Last Updated Month/Year

July 10, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care

Intended Users

Physician, paramedic emt, nurse, nurse practitioner, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D009293 - Opioid-Related Disorders

Keywords

Prescribing of Opioids, Adult Patients, Emergency Department, Critical issues

Source Citation

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Opioids; Hatten BW, Cantrill SV, Dubin JS, Ketcham EM, Runde DP, Wall SP, Wolf SJ. Clinical Policy: Critical Issues Related to Opioids in Adult Patients Presenting to the Emergency Department. Ann Emerg Med. 2020 Sep;76(3):e13-e39. doi: 10.1016/j.annemergmed.2020.06.049. PMID: 32828340.

Methodology

Number of Source Documents
89
Literature Search Start Date
January 1, 2007
Literature Search End Date
August 8, 2018