5 Responses to “Emergency Medicine’s Role in Prescription Opioid Abuse”

1. 

   July 26, 2015

   Frank Fower,MD,FACEP Reply

   The Fact is there is Narcotic Diversion from ER.
   The New Laws are Intenede to Curb this Diversion.
   No body will blame a provider for prescribing Narcotics for a Cancer patient or after splinting a fracture.
   Every body will point @ Providers who : Refill Narcotics for Chronic pains, and prescribing Narctocis for frequent. ER. clients that only visit ER under different scenarios with bottom line :Narcotic s prescribed. And for transients who forget / lost their Narcotics,
   And for ER shoppers that cross the town bypassing many Hospital s or maybe stopping by every Hospital on their path in big inner cities to visit a nice /soft prescriber.
   -my thought is we will Alleviate Pain, and treat what is causing this pain, we need to Refrain from being a source to easy obtain something for pain, after 30 years of ER practice , I did not find the Disease that some providers call Pain by itself and they just prescribe Narcotics to treat it.

2. 

   July 26, 2015

   Derek McCalmont MD Reply

   The author might have given some consideration to the fact that not all pain medications are opiates. Another unaddressed issue is what percentage of these prescriptions are being written for chronic or recurring complaints vs. new diagnoses. What percentage are being written for medically inappropriate conditions?

   When ED physicians address these questions at the same time they will be in a much better position to argue that limits on prescribing are harmful and intrusive.

3. 

   July 26, 2015

   Alex Genty CNP Reply

   Thank you for the extremely well written article above. As a NP staffing a remote/rural ER in a solo provider situation, I am familiar with the challenges of pain medication prescribing, particularly due to long waiting times to see specialists such as orthopedic surgery etc.

   Oklahoma (where I work) has some draconian laws regarding NP prescribing that definitely impact quality of care for patients with acute pain, and I would like to see ACEP development an Emergency Medicine specific pain management education program that is open to NPs and PAs as well as EM physicians. Education is clearly the key in safe and competent prescribing. The move in Massachusetts is just as poorly thought out as current NP/PA prescribing laws in states such as Texas and Oklahoma.

   I appreciate your thoughts and research in this area, and will use some of your resources to work to affect change, and enhance safety and quality of care in our NP staffed ER. It is my sincere hope that ACEP will open more education opportunities to NPs and PAs, because while a board certified EM physician in every ER is ideal, reality is that an EM certified nurse practitioner or PA with an EM CAQ is definitely better than a moonlighting ENT resident. The ability for NPs and PAs to access specific ACEP information and education, and perhaps become affiliated with ACEP in some way would be a huge step forward in improving quality and safety in emergency medicine practice and prescribing as well.

   Thanks again,

   Alex

4. 

   July 27, 2015

   Rob Oelhaf, MD Reply

   Thank you so much for this timely article. The pendulum has, indeed, swung too far in the minds of influential people on this topic. Treat acute pain with meds that work, using good judgement and appropriate, modest prescriptions while attempting to avoid the social profiling that got the oligoanalgesia ball rolling in the first place. I deeply appreciate your very sensible take on this problem and hope that this content is widely distributed.

5. 

   August 9, 2015

   Mark Ibsen MD Reply

   The Institute of Medicine report of 2011: Pain in America declared: the are 100 million Americans in pain. Opiophobia has replaced oligoanalgesia as the current Monday morning quarterback topic.
   Unintendended consequences abound.
   Addiction by other substances is not managed by ERs.
   Car dealers are not expected to screen customers for speeding tendencies.
   Heroin has become a massive problem because it is cheap and accessible- why?
   We were blamed for under treating pain, ER overcrowding, now this: we must stand FOR patients, and give up our role as scapegoats for societies’ ills.