Representatives from the New York City Department of Health and Mental Hygiene and the head of the American College of Emergency Physicians (ACEP) share opposing viewpoints on the recently released New York City Emergency Department Discharge Opioid Prescribing Guideline.
According to Alex M. Rosenau, DO, CPE, FACEP, President-elect of the ACEP, the guidelines may be missing the mark by targeting emergency room physicians. The new guidelines, which were promoted heavily by New York City Mayor Bloomberg's office, recommend that public hospital emergency department physicians prescribe no more than three days' supply of opioids upon discharge. But Dr. Rosenau points out that emergency physicians write less than 5 percent of the immediate release opioid prescriptions and a very small a proportion of the extended/long acting opioids.
He says there are many legitimate reasons for prescribing pain medications for more than three days and the guideline may hurt more than help by causing additional visits to the ER while patients await follow-up care. These additional visits will add to the crowding problem in the ER. Authors at NYC's Department of Health say the guideline is welcome support for emergency physicians who are accountable to patients seeking opioids for pain relief.
These doctors have a desire and obligation to help their patients, but they recognize that misuse, addiction, and death are real and common dangers of prescribing opioids. The authors cite evidence that long-term use of opioids for non-cancer pain is unsupported.
There is no good evidence that opioids control pain or improve function over the long-term. However, one study shows that opioid use results in addiction for more than one-third of chronic pain patients. The authors say that mayoral backing of the new prescribing guidelines gives physicians the support they need to promote safer opioid prescribing practices. The full guideline can be viewed at http://www.annals.org.