> Opioids

Opioids

Official guideline from the American College of Emergency Physicians.

summary by Eric Steinberg, DO

Outpatient Prescriptions

Acute Pain

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.

Level B

The use of a state prescription monitoring program may help identify patients who are at high risk for prescription opioid diversion or doctor shopping.

Level C

Research evidence to support superior pain relief for short-acting schedule II over schedule III opioids is inadequate.

Level C

Chronic Pain

Physicians should avoid the routine prescribing of outpatient opioids for a patient with an acute exacerbation of chronic noncancer pain seen in the emergency department (ED).

Level C

If opioids are prescribed on discharge, the prescription should be for the lowest practical dose for a limited duration (e.g. <1 week), and the prescriber should consider the patient’s risk for opioid misuse, abuse, or diversion.

Level C

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.

Level C

Acute Low Back Pain

For the patient being discharged from the emergency department (ED) with acute low back pain, the emergency physician should ascertain whether nonopioid analgesics and nonpharmacologic therapies will be adequate for initial pain management.

Level C

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.

Level C

If opioids are indicated, the prescription should be for the lowest practical dose for a limited duration (e.g. <1 week), and the prescriber should consider the patient’s risk for opioid misuse, abuse, or diversion.

Level C

What do the icons mean?

Level A

Generally accepted principles for patient management that reflect a high degree of clinical certainty (ie, based on strength of evidence Class I or overwhelming evidence from strength of evidence Class II studies that directly address all of the issues).

Level B

Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty (ie, based on strength of evidence Class II studies that directly address the issue, decision analysis that directly addresses the issue, or strong consensus of strength of evidence Class III studies).

Level C

Other strategies for patient management that are based on Class III studies, or in the absence of any adequate published literature, based on panel consensus.

Literature

Original/Primary Reference

Cantrill SV, Brown MD, Carlisle RJ, et al. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. Ann Emerg Med. 2012;60(4):499-525.

Calc Function

Outpatient Prescriptions

Acute Low Back Pain