Pa. unveils new ER guidelines for dispensing pain medications

Posted: Wednesday, August 13, 2014

Several times a day someone walks into the emergency room at St. Mary Medical Center complaining of pain and looking for medication to stop it, according to the department's director.

But not everyone seeking prescription painkillers leaves with the drugs or a prescription for them.

Three years ago, the Middletown hospital implemented new restrictions on how it dispenses controlled substances through its ER. The effort was part of an initiative to reduce the abuse and overdose deaths associated with opioid-based pain medications while also appropriately treating patients in pain.

The result has been fewer ER patients with pain complaints looking for prescriptions, Chairman of Emergency Medicine Dr. Gary Zimmer said.

The Pennsylvania Medical Society wants more hospitals to follow the efforts hospitals like St. Mary have put in place. At a press conference in Philadelphia on Wednesday, the organization announced the state’s new — voluntary — emergency department pain prescribing guidelines.

The recommendations are designed to make sure patients who are in pain get the relief they need, while also attempting to identify individuals who may be abusing controlled substances and refer them into treatment.

“As an emergency physician, I see the devastating impact of prescription drug abuse on a regular basis. I know this epidemic does not discriminate on the basis of race, age or gender,” said Dr. Ted Christopher, a medical society board member and emergency medicine doctor in Philadelphia.

National statistics confirm that prescription drug abuse in the U.S. has reached epidemic proportions. The National Institute on Drug Abuse estimated that 8.76 million Americans misused prescription drugs in 2010. The most abused prescription categories are painkillers, tranquilizers and stimulants.

Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills, according to Centers for Disease Control and Prevention in Atlanta.

The CDC estimates that drug misuse and abuse resulted in about 2.5 million emergency department visits in 2011, with more than half related to pharmaceuticals. Opioid pain relievers were involved in about 74 percent of the 22,810 deaths related to pharmaceutical overdoses in 2011, according to the CDC.

The new guidelines were created in collaboration with the Pennsylvania College of Emergency Physicians, which presented them to Gov. Tom Corbett’s Safe and Effective Prescribing Practices and Pain Management Task Force last month.

The task force has been charged with reviewing health care prescribing practices and identifying guidelines to promote safer and more effective pain management by health care providers. It is also working to ensure prescribers and dispensers are able to identify drug abuse and addiction problems in their patients in order to refer them for drug and alcohol assessment and for the appropriate level of treatment.

“These guidelines will help doctors break the deadly cycle of the unlawful obtaining of prescription drugs,” Pennsylvania’s Physician General Dr. Carrie DeLone said.

The list of seven prescribing guidelines include recommending providers choose the lowest potency necessary to relieve pain, when an opioid medication is indicated; dispensing only the amount of medication necessary to control a patient’s pain until they can access a pharmacy; and not writing discharge prescriptions that exceed seven days.

The guidelines also recommend emergency departments not prescribe long-acting opioids such as OxyContin, extended release morphine or methadone unless they coordinate with an outpatient provider.

“These guidelines are the next steps in fighting prescription drug abuse in Pennsylvania,” Christopher added. “Let’s not stop there. More work can be done and needs to be done in our battle against misuse and abuse of prescription drugs.”

The new state recommendations are similar to what St. Mary Medical Center has in place, Zimmer said.

St. Mary patients with chronic pain complaints can no longer automatically get refills through the ER; instead they are referred back to the prescribing doctor, Zimmer said. Also the hospital limits its discharge prescriptions to not exceed three days' worth of pain pills.

ER patients who are uninsured or don't have a pain management doctor are referred to two hospital-associated specialists who accept charity cases for follow-up care, Zimmer said.

Zimmer added that the hospital and its ER doctors are careful to make sure that pain patients are getting proper care in and out of the hospital setting.

“The reality is, unless a patient with chronic pain gets their care coordinated through a qualified pain management specialist, they are at very high risk for adverse events associated with controlled substances,” he said.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Did You Know?

Prescription painkiller work by binding receptors in the brain to decrease the perception of pain. The drugs can create a feeling of euphoria, cause physical dependence and, in some people, led to addiction. The drugs also cause sedation and slow a person’s breathing. It is one reason why an overdose on opioid drugs can take one to three hours after ingestion.