Myths and Facts of Opioid Policy Advocacy

1. Myth: Emergency Rooms are a major source of opioid prescriptions

Fact: Emergency departments are an important resource for patients with painful conditions. While emergency physicians do provide a short course of opioid pain medicine when deemed appropriate, the truth is that only 5% of the nation's opioid pills are prescribed out of the emergency department.  Despite the fact that nearly half of patients present to the Emergency Department for a pain related complaint, only 17% of discharged patients are prescribed opioid pain relievers. The majority of the prescriptions have small pill counts and almost exclusively immediate-release formulations.[v]
2Myth: Emergency Physicians are not concerned with opioid abuse
Fact: The American College of Emergency Physicians has created comprehensive recommendations on appropriate opioid prescribing. These recommendations include utilizing non-opioid pain management, only prescribing a short course of opioid medications when indicated, and accessing the prescription drug monitoring program when appropriate. Compared to all specialties, emergency physicians demonstrated the largest decrease in opioid prescribing rates between 2007 and 2012 with a drop of 8.9%.
Emergency physicians are in the unique position of witnessing the worst complication of opioid abuse: opioid overdose. 91 Americans die each day from opioid overdoses. Emergency departments across the country are treating opioid overdoses on a daily basis. This distinct experience puts emergency physicians at the forefront of the opioid crisis in regards to both prevention and treatment. 
3. Myth: Emergency Providers are incapable of regulating their own prescribing habits
Fact: ACEP has national policies on opioid prescribing and many state chapters have created their own prescribing policies.  These policies recommend avoiding long acting or extended release opioids, only using opioids only when medically necessary to treat acute pain, and using the lowest effective dose and shortage duration possible.  
ACEP has an entire section dedicated to pain management. Emergency departments across the country are exploring innovation non-opioid treatments for patients’ pain. These have included opioid free emergency departments, use of alternative non habit forming medications, as well as additional novel medical therapy such as trigger point injections and nerve blocks.  
4. Myth: Mandating providers to access a state’s prescription drug monitoring program on every patient is quick and effective
Fact: States have their own versions of prescriptions drug monitoring programs. The majority of these are slow and cumbersome and not integrated into the hospitals’ EMR. In a medical specialty where minutes can mean the difference between life and death, an extra five minutes at a computer and away from the patient beside can be disastrous. Multiply this five minutes by the millions of patients seen in the emergency departments each year and it becomes alarming how much critical patient care time is spent with these outdated prescription drug monitoring programs. 
A study analyzing mandated registration vs mandated use of the prescription drug monitoring program demonstrated no difference in the decrease in opioid prescribing between the two groups. While prescription drug monitoring programs can be helpful in appropriate prescribing, mandating providers to access the PDMP for every patient has not been shown to be beneficial over simply mandating registration for the database.
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