• Popular Recommendations

  • PEER
  • ultrasound
  • LLSA
  • sepsis

Opioids (Jun 2020)

Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department (June 2020)

Scope of Application

This guideline is intended for physicians working in emergency departments.

Inclusion Criteria

This guideline is intended for adult patients presenting in unscheduled acute care settings.

Exclusion Criteria

This guideline is not intended for use with pediatric patients.

Critical Questions

  • In adult patients experiencing opioid withdrawal, is emergency department-administered buprenorphine as effective for the management of opioid withdrawal compared with alternative management strategies?

    Recommendations
    Level A Recommendations

    None specified.

    Level B Recommendations

    When possible, treat opioid withdrawal in the emergency department with buprenorphine or methadone as a more effective option compared with nonopioid-based management strategies such as the combination of α2-adrenergic agonists and antiemetics

    Level C Recommendations

    Preferentially treat opioid withdrawal in the emergency department with buprenorphine rather than methadone.

    Level A Recommendations

    None specified.

    Level B Recommendations

    When possible, treat opioid withdrawal in the emergency department with buprenorphine or methadone as a more effective option compared with nonopioid-based management strategies such as the combination of α2-adrenergic agonists and antiemetics

    Level C Recommendations

    Preferentially treat opioid withdrawal in the emergency department with buprenorphine rather than methadone.

  • In adult patients experiencing an acute painful condition, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms?

    Recommendations
    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Preferentially prescribe nonopioid analgesic therapies (nonpharmacologic and pharmacologic) rather than opioids as the initial treatment of acute pain in patients discharged from the emergency department.

    For cases in which opioid medications are deemed necessary, prescribe the lowest effective dose of a short-acting opioid for the shortest time indicated.

    Level A Recommendations

    None specified.

    Level B Recommendations

    None specified.

    Level C Recommendations

    Preferentially prescribe nonopioid analgesic therapies (nonpharmacologic and pharmacologic) rather than opioids as the initial treatment of acute pain in patients discharged from the emergency department.

    For cases in which opioid medications are deemed necessary, prescribe the lowest effective dose of a short-acting opioid for the shortest time indicated.

  • In adult patients with an acute exacerbation of noncancer chronic pain, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms?

    Recommendations
    Level A Recommendations
    None specified.
    Level B Recommendations

    None specified.

    Level C Recommendations

    Do not routinely prescribe opioids to treat an acute exacerbation of noncancer chronic pain for patients discharged from the emergency department. Nonopioid analgesic therapies (nonpharmacologic and pharmacologic) should be used preferentially.

    For cases in which opioid medications are deemed appropriate, prescribe the lowest indicated dose of a short-acting opioid for the shortest time that is feasible.

    Level A Recommendations
    None specified.
    Level B Recommendations

    None specified.

    Level C Recommendations

    Do not routinely prescribe opioids to treat an acute exacerbation of noncancer chronic pain for patients discharged from the emergency department. Nonopioid analgesic therapies (nonpharmacologic and pharmacologic) should be used preferentially.

    For cases in which opioid medications are deemed appropriate, prescribe the lowest indicated dose of a short-acting opioid for the shortest time that is feasible.

  • In adult patients with an acute episode of pain being discharged from the emergency department, do the harms of a short concomitant course of opioids and muscle relaxants/sedative-hypnotics outweigh the benefits?

    Recommendations
    Level A Recommendations
    None specified.
    Level B Recommendations
    None specified.
    Level C Recommendations

    Do not routinely prescribe, or knowingly cause to be co-prescribed, a simultaneous course of opioids and benzodiazepines (as well as other muscle relaxants/sedative-hypnotics) for treatment of an acute episode of pain in patients discharged from the emergency department (Consensus recommendation).

    Level A Recommendations
    None specified.
    Level B Recommendations
    None specified.
    Level C Recommendations

    Do not routinely prescribe, or knowingly cause to be co-prescribed, a simultaneous course of opioids and benzodiazepines (as well as other muscle relaxants/sedative-hypnotics) for treatment of an acute episode of pain in patients discharged from the emergency department (Consensus recommendation).

Download the Policy

PDF Icon Opioids 2020.pdf June 2020

eCME Credit Available

Check your available credits through eCME learning portal.

Findings and Strength of Recommendations

Clinical findings and strength of recommendations regarding patient management were made according to the following criteria:
Level A recommendations
Generally accepted principles for patient care that reflect a high degree of clinical certainty (eg, based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).
Level B recommendations
Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).
Level C recommendations
Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of adequate published literature, based on expert consensus. In instances in which consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.
There are certain circumstances in which the recommendations stemming from a body of evidence should not be rated as highly as the individual studies on which they are based. Factors such as heterogeneity of results, uncertainty about effect magnitude, and publication bias, among others, might lead to a downgrading of recommendations.
LIVE CHAT
[ Feedback → ]