Emergency room physicians are often blamed for the rising number of opioid overdoses in the U.S. because they are generally the first to prescribe opioids to patients seeking pain relief. A 2016 article in the Annals of Emergency Medicine sought to address the issue and provide solutions and alternatives for patients.
Alexis LaPietra, DO, medical director of emergency medicine pain management at the St. Joseph’s Regional Medical Center’s Alternatives to Opiates Program, identified five conditions in which opioids may not be the best solution to manage pain: renal colic, migraines, lumbar radiculopathy, acute lower back pain, and fractures or dislocation of extremities.
Emergency physicians are constantly on the go, and one argument for prescribing opioids for pain has been physician productivity. However, Dr. LaPietra said that taking the time to explain to patients why prescribing them an opioid is not the best solution wouldn’t increase the length of time patients spend in the ER, nor would it compromise emergency physicians’ productivity.
In the first 60 days of the program, 75 percent of the 300 patients treated were given alternative treatments to opioids. According to LaPietra, new ways of treating pain are about “changing culture” in the ER
Emergency physicians can also use a prescription drug monitoring database (PDMP), which 49 states currently maintain. However, PDMP has its own limitations including “complicated mental math” that physicians need to do in order to ascertain a patient’s risk for overdose.
Dr. Scott D. Weiner, an emergency physician at the Boston-based Brigham and Women’s Hospital and MITRE Corporation researcher Jaya Tripathi, MS analyzed Indiana’s PDMP database and found several key predictors for an overdose. They used their findings to develop a tool for emergency doctors that makes quick calculations to assess a patient’s risk for overdose. The tool will be tested at Dr. Weiner’s hospital to determine whether it increases the use of PDMPs in hospitals, and provides quick patient opioid overdose risk assessments.
Between 2001 and 2010, the percentage of opioid prescriptions for adults written in the emergency department of hospitals increased from 20.8 percent to 31 percent, according to a study by researchers from George Washington University. These included opioids that were given to patients while they were in the emergency department or as they left the hospital. However, a year later, a study published in the journal Annals reviewed charts of 19 emergency department patients during one week in 2012 and found that only 17 percent of discharged patients received a prescription for an opioid pain reliever.
U.S. Food and Drug Administration (FDA) data from 2009 showed that emergency room physicians were actually ranked fifth for specialties that prescribe opioids. Family practitioners ranked first, followed by internists, dentists and orthopedic surgeons, the data showed.
Dr. Maryann Mazer-Amirshahi, Pharm.D., who was the lead researcher on the George Washington study, stated that emergency room physicians aren’t the biggest piece of the puzzle. “The solution isn’t going to be one practice setting,” she said.