No pain meds in ER??

Axgrinder · Apr 2, 2016

What happens when an AMI comes to this ER? Isn't MSO4 IVP the standard of care, along with NTG SL, O2 via NC, and low dose asa? Holy cow - have I been out of acute care that long? Are they instituting another method of care now?

Anna Flaxis, BSN, RN · Apr 2, 2016

I think folks should read the article before commenting. They're not doing away with pain meds in the ER. They're not doing away with opiates in the ER. What they are doing is using a more targeted strategy, using the therapies that are medically indicated rather than just throwing Vicodin and Percocets at everybody who walks in the door. Here is a more informative article on this:

Top Stories - Opioid Crisis Motivates Hospitals to Reduce Drug’s Use in ERs - AllGov - News

oldmamapuss · Apr 2, 2016

Maybe it's just my cynical mind at work. Targeting prescription opioids rather than cracking down on heroin entering the country seems like the wrong way to go about it. In New York, you can walk into a pharmacy and purchase syringes without a prescription, no questions asked. The pharmacist I know said it was done to try to control sharing contaminated needles to combat AIDS and hepatitis. So, the government is encouraging IV heroin use, isn't it? You can also buy beer at the same pharmacy, along with your needles. Somehow, this doesn't seem like the right way to address the heroin epidemic.

WOW you can do that??? I'm in England. I thought it was bad enough that we sell beer, wine and spirits at the garage.

OT This is my first post, I'm 55, qualified in 1982. Currently doing LTC but thinking of a change

Medicarenurse1 · Apr 2, 2016

Went to an ER six months ago with an acute kidney stone, 200 + miles from home, knowing it was probably a kidney stone. Drove to a hospital I was familiar with in the area (I travel the state as a reimbursement nurse for LTC.) Could barely walk when I came in the door, and was given two acetominophen. By the time they got a scan, it had passed into my bladder. I point blank asked the Dr if he thought his treatment of my situation was appropriate, and he said yes. I disagree. 2mg morphine would have reduced the spasms that I had after the fact. On the other hand after I had a car accident, in an ER 300 miles away, but still 200 miles from home, I was offered and almost received 10 mg morphine for the after effects of a roll-over car accident from which I walked away with a tiny scratch on my hand and a mild concussion. 10 mg was totally uncalled for, and 2 mg did the trick. There don't seem to be any standards for opiate use. When they are needed, they are NEEDED. But a 120 lb person who can walk probably doesn't need 10mg. Fractures would have been a different story. And meanwhile in my every day life, my chronic arthritis pain is managed with doses of Advil and ASA that are far more harmful than opiates would be.

Harley's mom · Apr 2, 2016

I feel that limiting the use of opioids should be done at the doctor's discretion at EVERY facility. I have found that instead of arguing with the "seeker" they will give them what they want so they can move on to the next patient. To outlaw them completely for patients who truly need them seems cruel. The docs need to get a backbone and stop catering to the seekers. As far as dependence caused from ER visits? Seriously? Maybe the primary care docs shouldn't be handing out scripts for obscene amounts of pain pills with numerous refills.

Popoagie, ADN, EMT-P · Apr 2, 2016

The New Jersey hospital isn't doing anything ground breaking. I've worked in a couple of ER's that tout "no narcotic" treatment. There are truths and lies with all of it. There will ALWAYS be that one Doc that gives them, and the masses will learn what he or she drives to work. There also will be that one Doc that adheres to the policy and will send home that fractured tib/fib with ibuprofen that you will get to see again because their pain is out of control. Did it change drug seeking behaviors? Not that I saw. It may have decreased a few lortab on the streets, but why buy lortab when heroine is dirt cheap? Tramadol is the new pain med in the ER. I just long for the days of common sense, when you could look a patient in the eye and say "you stubbed your toe....it doesn't require an opioid and when follow up with you PCP meant something.

dave4151 · Apr 2, 2016

In answer to the question should opioids be pulled from EDs? Absolutely not. This is a crazy backward swing on the pain management issue. For years we've been told to treat all pain. Now that some patients are abusing them, patients who have a true need for such meds are being left in agony through no fault of their own. A good practitioner should be able to assess whether a patient is truly in pain or not. Also, based on the state, a provider can check a database (PDMP - Prescription Drug Monitoring Program) to see if the patient is receiving opioids from other providers. It takes an extra 5 minutes but that database is there for a reason; to allow patients to receive opioids while providers state-wide can monitor their use of opioids. Please see CDC page State Successes

| Drug Overdose | CDC Injury Center showing excellent results from use of these databases. There should be a nationwide version.

Dragonnurse1, ASN, RN · Apr 3, 2016

I worked in the ER for just over 9 years and saw many overdoses but those that died did so not from the opiates but from the acetaminophen. Most died from liver failure some time after the fact. Not one of our OD's were from the opiate itself. We saw our fair share of patients wanting narcotics. Most of the "drug seekers" wanted their doses in IV form and would try to sneak out with the INT intact. But we did not routinely write opiate prescriptions in the ED. Most patients got scripts for toradol or naproxen sodium. We reserved the dilaudid for sickle cell patients, MSO4 was saved for cardiacs, open fractures, kidney stones and other severe traumas. I have also seen raglan stop a migraine mid-attack. We were doing that 10 years ago. If our Doc's did write a narcotic it was for only 2 days with a referral to another doctor. We treated the pain without going overboard. What is wrong with that formula? Patients are being treated as customers. Somewhere along the line administrator's decided that the "customer" is always right however patients may know what they want but not what they need. It is up to all hospital's and ER doctors to give them what they NEED. Patients need to go back to being patients not customers.

But what frightens me is the effect these new actions will have on my pain management. I have been in pain management for 8 years now. I have had 2 surgeries for herniated disks in my neck, there is one in my lower spine now but I am no longer a surgical candidate. I have a right shoulder that needs replacement and a bum knee. Most nights I do not sleep well even thought I am on Norco 10's 4 times a day. I nave never yet experienced a "high" due to the medication. I could not get out of bed without my meds but I do not know if my pain management doctor will be allowed to continue my current treatment (meds plus injections).

Removing opiates from ER's is just the first step those of us that live with chronic pain have been totally overlooked.

R. Obias Jr., R.N. · Apr 3, 2016

People are using this issue on opiates to support the legalization of use of the substance as an over the counter drug.

Donoharmtakenocrap · Apr 3, 2016

ED patients don't get surveyed

nrfitchett4 · Apr 3, 2016

I see both sides. I have a wide who had chronic pain issues and I know that many people abuse narcotics. I think it is telling that we use a major amount of the world's narcotics. What are other countries doing that we are not? I know in France they don't prescribe near as much ADHD medications and have better results.

Why do 20% of the patients discharged need a narcotic? Post op narcotic use should be short term. I've seen plenty of patients do great on Tylenol and motrin on about day 3. Many patients also get those pain balls as well. Something needs to be done but is a tough subject.

ShaneTeam · Apr 3, 2016

In answer to the question should opioids be pulled from EDs? Absolutely not. This is a crazy backward swing on the pain management issue. For years we've been told to treat all pain. Now that some patients are abusing them, patients who have a true need for such meds are being left in agony through no fault of their own. A good practitioner should be able to assess whether a patient is truly in pain or not. Also, based on the state, a provider can check a database (PDMP - Prescription Drug Monitoring Program) to see if the patient is receiving opioids from other providers. It takes an extra 5 minutes but that database is there for a reason; to allow patients to receive opioids while providers state-wide can monitor their use of opioids. Please see CDC page State Successes
| Drug Overdose | CDC Injury Center
showing excellent results from use of these databases. There should be a nationwide version.

Thanks, forgot about those. Kansas uses state wide (KTracs).