Prescribing Opioids (2012)

• Inclusion: Adult with acute non-cancer pain or acute exacerbation of chronic non-cancer pain
• Exclusion: Long term care of patients w cancer or chronic non-cancer pain
• Level A:
• Level B:
  • Short-acting opioids such as oxycodone or hydrocodone for short term relief of acute musculoskeletal pain
• ‘Level C:
  • Use of state prescription monitoring program may help identify patients at high risk for prescription opioid diversion or doctor shopping.
  • For patient being discharge from ED w acute low back pain, EP should ascertain whether non-opioid analgesics and non-pharmacologic therapies will be adequate
  • Opioids reserved for more severe pain or pain refractory to other analgesics
  • Unknown benefit of short-acting schedule II over schedule III opioids.
  • If opioids indicated, prescription for lowest practical dose for limited duration <1 week), and should consider risk for misuse, abuse, or diversion.
  • Avoid prescribing outpatient opioids for a patient with an acute exacerbation of chronic non-cancer pain.
  • Honor existing patient-physician pain contracts/treatment agreements and consider past prescription patterns.

Clinical policy: Critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012;60:499-525.PDF