The Opioid Epidemic and Emergency Department Prescribing Practices
In 2001, the Joint Commission rolled out its Pain Management Standards which advocated the idea of pain as a "fifth vital sign”. This mandate required healthcare providers to ask every patient about their pain despite, unlike all of the other vital signs, there is no objective measurement available. Since then, overdose related deaths have gone up over 400%. The current CEO of the Joint Commission has asked for a reassessment of the so-called “fifth vital sign”. In addition, there have been reimbursement policies tied to patient satisfaction that have created pressures on clinicians to overprescribe narcotic analgesics. In a recent New Yorker article Purdue Pharmaceutical, a physician-owned company, has been blamed for a “lion’s share” of the epidemic. In recent years, there has been an attempt to provide guidelines such as the ACEP’s Clinical Policy, as well as the CDC and NIH guidelines. A recent EmCrit guest is advocating for an Opioid-Free-ED using alternative drugs such as ketamine and IV lidocaine. Another area of discussion is how to best mitigate the often frustrating and seemingly endless circular discussions we have with so-called drug seeking patients. I’ll look forward to hearing your clinical pearls on how you best manage these challenging patients.
Weiner SG et al, The Effect of Opioid Prescribing Guidelines on Prescriptions by Emergency Physicians in Ohio. Ann Emerg Med. 2017 Dec;70(6):799-808. Appraisal
Chang AK et al, Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. JAMA. 2017 Nov 7;318(17):1661-1667 Appraisal
Barnett ML, et al, Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use. N Engl J Med. 2017 Feb 16;376(7):663-673 Appraisal
Keefe: The Family That Built an Empire of Pain The New Yorker October 30th, 2017