Emergency Department Opioid Prescribing Guidelines for the Treatment of Non-Cancer Related Pain

Executive summary
Pain is one of the most common chief complaints among emergency department patients with a reported rate of over 50%.(1) There is great variability among emergency clinicians in the management of pain, especially with respect to the use of opioid medications.(2) Importantly, morbidity and mortality have increased as the frequency of opioid use for the treatment of pain has increased.(3) This includes a significant increase in non-medical opioid use, addiction, drug-related emergency department visits, and death.(4)(5) The dangers of prescribing opioid medications extend beyond the individual patient and may adversely impact public health.(6) Approximately 13% of high school seniors have reported non-medical use of prescription opioids. Despite emergency departments prescribing only a fraction of those prescriptions written nationally, ED prescriptions for opioids are reported to account for approximately 45% of those opioids diverted for non-medical use.(7)

These guidelines were developed to provide the emergency clinician with recommendations regarding the safe, effective, and ethical practice of pain management in the emergency department setting. These recommendations may be adopted in whole or in part and should be adapted to address individual hospital policies along with state and local regulations. This document is not meant to replace the judgment of the treating clinician who is in the best position to determine the needs of the individual patient.

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References and Literature Grading (PDF)