Pain management/clinical policy
Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

https://doi.org/10.1016/j.annemergmed.2012.06.013Get rights and content

Section snippets

Abstract

This clinical policy deals with critical issues in prescribing of opioids for adult patients treated in the emergency department (ED). This guideline is the result of the efforts of the American College of Emergency Physicians, in consultation with the Centers for Disease Control and Prevention, and the Food and Drug Administration. The critical questions addressed in this clinical policy are: (1) In the adult ED patient with noncancer pain for whom opioid prescriptions are considered, what is

Methodology

This clinical policy was created after careful review and critical analysis of the medical literature. The critical questions were formulated in the PICO (patient, intervention, comparison, outcome)29 format to strengthen the clarity and scientific rigor of the questions. Searches of MEDLINE, MEDLINE InProcess, and the Cochrane Library were performed. All searches were limited to English-language sources, human studies, adults, and years 2000 to 2011. Specific key words/phrases and years used

1. In the adult ED patient with noncancer pain for whom opioid prescriptions are considered, what is the utility of state prescription drug monitoring programs in identifying patients who are at high risk for opioid abuse?

Recommendations

Future Research

Provider pain management practices related to opioids are highly variable. In part, this variability reflects the lack of evidence to guide many of these therapeutic decisions.76 Although there is high-quality research assessing the treatment of acute pain with opioid analgesics during the ED encounter, there is a paucity of studies assessing the benefits of prescribing opioids for discharged ED patients with acute pain and chronic noncancer pain, especially in comparison to other analgesic

First page preview

First page preview
Click to open first page preview

References (79)

  • E. Kalso et al.

    Opioids in chronic non-cancer pain: systematic review of efficacy and safety

    Pain

    (2004)
  • G.E. Ruoff et al.

    Tramadol/acetaminophen combination tablets for the treatment of chronic lower back pain: a multicenter, randomized, double-blind, placebo-controlled outpatient study

    Clin Ther

    (2003)
  • M.E. Hale et al.

    Efficacy and safety of oxymorphone extended release in chronic low back pain: results of a randomized, double-blind, placebo- and active-controlled phase III study

    J Pain

    (2005)
  • M.K. Jensen et al.

    10-Year follow-up of chronic non-malignant pain patients: opioid use, health related quality of life and health care utilization

    Eur J Pain

    (2006)
  • R.M. Arnold et al.

    Opioid contracts in chronic nonmalignant pain management: objectives and uncertainties

    Am J Med

    (2006)
  • J.H. Tamayo-Sarver et al.

    Variability in emergency physician decisionmaking about prescribing opioid analgesics

    Ann Emerg Med

    (2004)
  • I.R.H. Rockett et al.

    Assessing substance abuse treatment need: a statewide hospital emergency department study

    Ann Emerg Med

    (2003)
  • C.A. Grover et al.

    Quantifying drug-seeking behavior: a case control study

    J Emerg Med

    (2012)
  • M.J. Pletcher et al.

    Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments

    JAMA

    (2008)
  • D.M. Phillips

    Joint Commission on Accreditation of Healthcare OrganizationsJCAHO pain management standards are unveiled

    JAMA

    (2000)
  • Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research

    (2011)
  • L.J. Paulozzi et al.

    Increasing deaths from opioid analgesics in the United States

    Pharmacoepidemiol Drug Saf

    (2006)
  • C.A. Porucznik et al.

    Studying adverse events related to prescription opioids: the Utah experience

    Pain Med

    (2011)
  • J. Xu et al.

    Deaths: Final Data for 2007

    (2010)
  • L.J. Paulozzi et al.

    Vital signs: overdoses of prescription opioid pain relievers—United States, 1999-2008

    Morb Mortal Wkly Rep

    (2011)
  • M. Warner et al.

    Drug Poisoning Deaths in the United States, 1980-2008

    (2011)
  • Automation of Reports and Consolidated Orders System (ARCOS)

  • M. Von Korff et al.

    Long-term opioid therapy reconsidered

    Ann Intern Med

    (2011)
  • D. Grady et al.

    Opioids for chronic pain

    Arch Intern Med

    (2011)
  • I.A. Dhalla et al.

    Facing up to the prescription opioid crisis

    BMJ

    (2011)
  • R. Chou et al.

    Opioid treatment guidelinesClinical guidelines for the use of chronic opioid therapy in chronic noncancer pain

    J Pain

    (2009)
  • Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain

    (2010)
  • Washington emergency department opioid prescribing guidelines

  • Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain

    (2009)
  • ACOEM's Guidelines for the Chronic Use of Opioids

    (2011)
  • Cautious, evidence-based opioid prescribing

  • N.D. Volkow et al.

    Characteristics of opioid prescriptions in 2009

    JAMA

    (2011)
  • G.R. Bond et al.

    The growing impact of pediatric pharmaceutical poisoning

    J Pediatr

    (2012)
  • L.M. Tormoehlen et al.

    Increased adolescent opioid use and complications reported to a poison control center following the 2000 JCAHO pain initiative

    Clin Toxicol

    (2011)
  • Cited by (0)

    Approved by the ACEP Board of Directors, June 14, 2012

    Supported by the Emergency Nurses Association, July 18, 2012

    View full text