Oct 16, 2015
Opioids are extraordinary agents that have been used for millennia
for the relief of pain and suffering; however, the history of
opioids is also one of abuse and addiction. In the US, we are in
the midst of a devastating iatrogenic chapter in this history, a
prescription opioid epidemic that kills 15,000 Americans per year
by overdose and destroys hundreds of thousands of lives and
families.
In this presentation we will consider the magnitude and
consequences of the current epidemic; describe how clinical
organizations and clinicians were appropriated by the
pharmaceutical industry so that Americans–5% of the world’s
population–consume more prescription opioids than the rest of the
world combined; and discuss strategies for managing patients who
present to emergency departments with acute or chronic pain
complaints that account for our competing mandates to palliate and
protect.
These strategies center on an assessment of the likelihood that
using opioids will deliver benefit or cause harm. For patients at
low risk to be harmed by opioids, utilize aggressive multimodal
analgesia, including opioids as needed to control acute pain, and
prescribe optimal outpatient non-opioid analgesia with a small
number of breakthrough opioids if indicated. For patients at high
risk to be harmed by opioids, including patients with chronic pain
and patients with flags for opioid misuse, avoid using opioids in
the ED and outpatient settings, utilize non-opioids to manage
symptoms, and, when misuse is suspected, nudge the patient to
addiction treatment. The goals of optimal opioid stewardship are to
provide effective symptom relief while preventing de novo cases of
addiction, to control the supply of opioids in the community, and
to protect existing addicts from further harm while promoting
recovery.
For slides, the HELPCard treatment referral business card, and
phraseology to use when managing patients at risk for opioid
misuse, go to http://emupdates.com/help