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Resources  |  Opioid Pain Management

Acute Care Opioid Treatment and Prescribing Recommendations: Emergency Department

 

Emergency Department (ED)

For patients presenting with acute exacerbation of chronic non-cancer pain

  • Non-opioid therapies should be used as first line therapy.
  • Lost or stolen prescriptions should not be replaced.
  • The prescription drug monitoring program (PDMP) must be accessed prior to prescribing controlled substances schedules 2-5, in compliance with Michigan law.
  • Consider care coordination and/or effective ED-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) with patients that have suspected risky opioid use or frequent ED visits.

For patients in methadone maintenance programs

  • Replacement methadone should NOT be provided in the Emergency Department (ED).

For patients presenting with acute painful conditions

  • Non-opioid therapies (e.g., acetaminophen, ketorolac) are encouraged as primary or adjunctive treatments.
  • Non-pharmacologic therapies (e.g., ice, splinting) should be utilized.
  • The prescription drug monitoring program (PDMP) must be accessed prior to prescribing opioids, in compliance with Michigan law.
  • Meperidine (Demerol) should not be used.

For patients discharged from the ED with an opioid prescription for acute pain

  • Long-acting opioids (e.g., fentanyl, methadone, OxyContin) should NOT be prescribed.
  • Short-acting opioids (e.g., hydrocodone, oxycodone) should be prescribed for no more than three-day courses.
  • Do not prescribe opioids with benzodiazepines and other sedatives.
  • Information should be provided about opioid side effects, overdose risks, potential for developing dependence or addiction, avoiding sharing and non-medical use, and safe storage and disposal.
  • Consider offering a naloxone co-prescriptions to patients who may be at an increased risk for overdose, including those with a history or overdose, a substance use disorder, those already prescribed benzodiazepines, and patients who are receiving a higher doses of opioids (e.g., >50 MME/day).

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