Opioid Prescription Stewardship
Pain management is a big deal in the ED. Emergency physicians can play a key role in addressing the opioid crisis by preventing addition. Overdose prevention starts with savvy opioid prescription habits. Several new and innovative strategies address how to be judicious when prescribing opioid medications.
- Be strategic in the use of opioids.
– Do not initiate opioids in the treatment of chronic pain
– Prescribe the lowest effective dose, for the shortest course appropriate
– Be upfront with the risks of opioid treatment including addiction
– Consider offering naloxone to patients with high risk of overdose
– Review the patient’s controlled substance prescription using local prescription monitoring programs
- Using opioid alternatives when possible (Alternatives to Opioid Therapies- ALTO)
– non-opioid IV/PO medications: such as Toradol for acute muscle strains or IV lidocaine in the treatment of ureterolithiasis
– trigger-point injections: such as occipital nerve blocks in the case of tension headaches
– nitrous oxide: as an alternative to opioids in conscious sedation
– ultrasound-guided nerve blocks: extremity fracture and dislocation reductions
By reducing the quantity and duration of opioid medication usage and substituting opioids with alternative therapies, ED providers can prevent unnecessary opioid exposure. Much of the responsibility for opioid stewardship is dependent on thoughtful and engaged providers. These new and innovative approaches offer new tools in the fight against opioid addiction.
Rosenberg, M. (2016, June). Alternatives to Opiates (ALTO) Program. Retrieved August 6, 2018, from https://www.aha.org/system/files/content/16/16behavhealthcaseex-stjosephs.pdf
Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) 18-4742PT3. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.