In such cases, there’s no objective evidence of disease – back pain, neuropathy, etc – but that doesn’t mean there isn’t real pain.

If I say no, I run the risk of patient complaints and a letter from the CEO. If I say yes, I then get bogged down in negotiations over how much and what drug. The guidelines offer a compromise: a limited supply of less potent meds. If the patient ups the ante or tries to demand more, I can point to the guidelines and explain that we have a policy.

Even better there are clear guidelines against refills and treating of chronic non-cancer pain in the ED. All this gives doctors the institutional backing to say no, and tacitly recognizes that doctors have been complicit in creating the problem through excessive opiate use.

I note that endorsing the proposal in NYC was the New York chapter of ACEP, which is also heartening. The problem of ER abuse and prescription narcotic addiction/diversion is a real issue, and it is growing.

We, as ER physicians, need to take ownership of the problem, as much as we can, and take leadership in developing measures to mitigate the problem. If we don’t, then it is predictable that someone else, likely state governments, will come in and impose their solutions on us – and those “solutions” are likely to be heavy-handed, draconian, and probably ineffective.

From what I can tell, New York’s approach seems well reasoned and hopefully effective. I am encouraged by an addendum that several private hospitals in the NYC area have announced they are also going to follow these guidelines (which properly only apply to city-owned hospitals). I’m also pleased that the process we went through in our state has begun to be used as a model for other states to follow!

Dr. Yore is an emergency physician and administrator living in the Pacific Northwest. This is an abridged version of the orignal blog, which appeared at the blog site allbleedingstops.blogspot.com. Dr. Yore routinely blogs under the name of Shadowfax.