Prescribing of Opioids for Adult Patients in the Emergency Department
Publication Date: October 1, 2012
Last Updated: March 14, 2022
Patient Management
When possible, treat opioid withdrawal in the ED with buprenorphine or methadone as a more effective option compared with nonopioid-based management strategies such as the combination of α2-adrenergic agonists and antiemetics. (B)
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Preferentially treat opioid withdrawal in the ED with buprenorphine rather than methadone. (C)
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Preferentially prescribe nonopioid analgesic therapies (nonpharmacologic and pharmacologic) rather than opioids as the initial treatment of acute pain in patients discharged from the ED.
For cases in which opioid medications are deemed necessary, prescribe the lowest effective dose of a shortacting opioid for the shortest time indicated. (C)
For cases in which opioid medications are deemed necessary, prescribe the lowest effective dose of a shortacting opioid for the shortest time indicated. (C)
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Do not routinely prescribe opioids to treat an acute exacerbation of noncancer chronic pain for patients discharged from the ED. Nonopioid analgesic therapies (nonpharmacologic and pharmacologic) should be used preferentially. For cases in which opioid medications are deemed appropriate, prescribe the lowest indicated dose of a shortacting opioid for the shortest time that is feasible. (C)
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Do not routinely prescribe, or knowingly cause to be co-prescribed, a simultaneous course of opioids and benzodiazepines (as well as other muscle relaxants/sedative-hypnotics) for treatment of an acute episode of pain in patients discharged from the ED. (C)
(Consensus recommendation)
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Recommendation Grading
Overview
Title
Prescribing of Opioids for Adult Patients in the Emergency Department
Authoring Organization
American College of Emergency Physicians
Publication Month/Year
October 1, 2012
Last Updated Month/Year
June 21, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This clinical policy deals with critical issues in prescribing of opioids for adult patients treated in the emergency department (ED)
Target Patient Population
Patients with acute non-cancer pain/exacerbation of chronic pain
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Emergency care
Intended Users
Paramedic emt, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D059350 - Chronic Pain, D059408 - Pain Management, D010146 - Pain, D059787 - Acute Pain
Keywords
opioids, acute pain, noncancer pain
Source Citation
Ann Emerg Med. 2012;60:499-525.