Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department

Patient Guideline Summary

Publication Date: June 1, 2020

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the American College of Emergency Physicians (ACEP) for critical issues in the prescribing of opioids for adult patients in the emergency department. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Opioids like morphine are highly effective in relieving severe pain. Unfortunately, they also carry a high risk of dependency and respiratory depression that can be fatal.

We will use the abbreviation ED throughout this summary to refer to the emergency department.

Opioids can also have unpleasant side effects such as vomiting, nausea, constipation, dizziness, drowsiness, headache, pruritis (itching), and dry mouth.

This patient summary focuses on the management of opioids in the emergency department, both for prescribing and for treating overdose.

Treatment

Overdose

Naloxone is the treatment for opioid overdose.
After withdrwal has been precipitated by naloxone, the first choice to treat opioid overdose is either buprenorphine or methadone.
- Buprenorphine is preferred over methadone.
- Non-opioid drugs are less effective.

Pain

At discharge from the ED, combining several non-opioid pain management choices can effectively avoid opioids and is preferred.
For a sudden worsening of chronic pain, non-opioid pain management is still preferred.
If opioids appear necessary, the lowest effective dose of a short-acting opioid for the shortest time is recommended.
Sedative, hypnotic (sleep-inducing) or muscle relaxing drugs should not be added to an opioid prescription except in rare cases.

Abbreviations

ACEP: American College Of Emergency Physicians

Source Citation

American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Opioids; Hatten BW, Cantrill SV, Dubin JS, Ketcham EM, Runde DP, Wall SP, Wolf SJ. Clinical Policy: Critical Issues Related to Opioids in Adult Patients Presenting to the Emergency Department. Ann Emerg Med. 2020 Sep;76(3):e13-e39. doi: 10.1016/j.annemergmed.2020.06.049. PMID: 32828340.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.