New York City Emergency Department Discharge Opioid Prescribing Guidelines

The following is copied from the New York City Emergency Department Discharge Opioid Prescribing Guidelines. A direct link to the complete guidelines is HERE.

Background

With increased use of prescription opioid analgesics for the treatment of pain, misuse also has increased, as have the use of medical services and deaths associated with opioid analgesics. From 2002-2003 to 2008-2009, self-reported, non-medical prescription opioid use increased by 40% with four % of New Yorkers aged 12 and older (263,000) reporting misuse. Between 2004 and 2009, the rate of opioid analgesic-related emergency department (ED) visits in New York City doubled, rising from 55 to 110 visits for every 100,000 New Yorkers. In 2009, one in every four unintentional drug poisoning (overdose) deaths (158) in New York City involved prescription opioid analgesics, a 20% increase from 2005.
The New York City Department of Health and Mental Hygiene created these guidelines to help reduce the misuse of prescription opioid analgesics by establishing standards for prescribing from the ED. In developing the guidelines, the Health Department was cognizant of the need to preserve the vital role of the ED in treating patients with painful medical conditions. These guidelines are consistent with the City Health Information bulletin on Opioid Prescribing, “Preventing Misuse of Prescription Opioid Drugs,” and were informed by opioid prescribing guidelines in other jurisdictions.3,4 They also incorporate input from a panel of New York City ED providers. The guidelines are not meant for patients in palliative care programs or with cancer pain. They do not replace clinical judgment in the appropriate care of patients nor are they intended to provide guidance on the management of patients while they are in the ED.