Pa. ER docs told to limit opioid prescriptions

    Pennsylvania announced new emergency room opioid prescribing guidelines Wednesday to stem the tide of prescription drug abuse.

     

    The guidelines advise Keystone State emergency room doctors to limit prescriptions for short-acting opioid painkillers, such as Vicodin and Percocet, to a week’s supply.

    They also say providers should not prescribe OxyContin, methadone or extended-release morphine without coordinating with the patient’s primary care physician.

    The prescribing guidelines aim to limit access for people addicted to painkillers and lower the risk of patients becoming addicted in the first place.

    “Emergency departments are magnets for abuse and misuse of opioids,” said Pennsylvania Physician General Dr. Carrie DeLone. “Developing these guidelines will allow adequate treatment of pain while also simultaneously making it more difficult to abuse these medications.”

    An increase in prescribing pain medication in the mid-to-late 1990s led to a current quadrupling of opioid and heroin abuse and overdoses, according to Department of Drug and Alcohol Programs Secretary Gary Tennis.

    “There was a focus on eliminating pain altogether. It was stated at that time that the risk of addiction was overstated, we didn’t need to really worry about that,” Tennis said at a press event Wednesday. “Now we see the result.”

    Officials say prescription painkillers now claim more lives nationally than heroin and cocaine combined.

    The new guidelines follow a similar set adopted by the American College of Emergency Physicians in 2012, which some Philadelphia-area hospitals are already using.

    Robert McNamara, chair of Temple University’s emergency department, said that health system has had opioid prescribing guidelines in place for about a year. He said the rules can make it easier for doctors to refuse addicted patients looking for a fix.

    “Frankly the patients can be confrontational and threatening, and it can be a difficult encounter for the doctors and nurses,” McNamara said. “When you have a written guideline such as this one…to hand out to the patient and say ‘This is what we follow,’ I think it’s helpful.”

    Doctors say they are still waiting on the Pennsylvania Legislature to pass a bill allowing the development of a controlled substances database, which would help them identify patients with a history of substance abuse.

    “If a clinician has a suspicion that a patient may be trying to get opioid prescriptions for other reasons than actual pain control, or that they’re getting their pain medications from multiple providers….we have no way, right now, to confirm our suspicions,” said Ralph Riviello, emergency medicine professor at Drexel University College of Medicine.

    Wednesday’s announcement is part of a larger Corbett administration effort to address prescription drug addiction. It follows guidelines announced for chronic pain management in Pennsylvania last month.

    Also included in the new emergency department guidelines:

    Patients should not receive opioid prescriptions for chronic or recurrent pain from multiple providers
    Patients whom doctors think may be addicted should be encouraged to seek detox help
    Doctors should consider non-opioid medication alternatives 
    Emergency department doctors should only dispense the amount of opioids needed until a patient can get to a pharmacy

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