No Pain, No Thebaine: Opioids in the Emergency Department.

Background: Opioid misuse has reached epidemic levels. Forty-six people die every day in the U.S. from prescription opioids. Opioid-taking patients cost emergency departments (EDs) and society more than non-opioid-taking patients. Many patients prescribed opioids will go on to become addicted, yet we find it much easier to prescribe these medications than explain to the patient why they are not indicated. The ED takes care of many of these people, whether by prescribing opioids, or treating opioid misuse. We examine the ED's role in this epidemic.

Methods: Data were obtained through literature search and the authors' personal experiences treating patients in the ED. The search was limited to specific harm to patients, hospitals, and society caused by opioid misuse, physiology of pain, and possible methods to manage the problem.

Conclusions: The ED clearly deserves some of the blame for the opioid epidemic. A consistent reinforcement of appropriate expectations for management of chronic pain across the medical spectrum will do much to manage the problem. We offer some ways to improve the problem, including pain contracts, pain guidelines, alternative therapies, pain management referrals, high-risk patient profiles, legislation, and drug take-back programs.