Here is a recently updated version of the guidelines for prescribing addictive pain medicine (opioids) at Temple University Hospital's emergency department.
Objective: To appropriately relieve pain for patients and attempt to identify those who may be abusing or addicted to opioids and refer them for special assistance.
Guidelines for treating non-cancer pain
1. Opioid analgesics may be appropriate for acute illness or injury when less addictive therapies such as NSAIDs (nonsteroanti-inflammatoryatory drugs) or acetaminophen are contraindicated or deemed inadequate to reasonably control pain.
a. Physicians should prescribe the least addictive medications that are expected to provide appropriate analgesia. When appropriate, the physicians should consider prescribing Schedule III or Schedule IV drugs instead of Schedule II drugs (see table).
b. Emergency physicians should not prescribe long-acting opioids such as OxyContin, extended release morphine or methadone.
2. Discharge prescriptions are limited to the amount needed until follow up and should not exceed 7 days' worth.
3. The patient should not receive opioid prescriptions from multiple doctors. Emergency physicians should not prescribe additional opioids for a condition previously treated in our ED, in another ED, or by another physician.
4. Emergency physicians should not replace lost or stolen prescriptions for controlled substances.
5. Emergency physicians should not prescribe opioids to patients who have run out of pain medications. Refills are to be arranged with the primary or specialty prescribing physician.
6. Opioids are discouraged for dental and back pain, whether acute or chronic.
a. Non-opioid alternatives such as dental block or NSAIDs may be offered.
7. Opioids should not be used to treat migraines, gastroparesis, or chronic abdominal/pelvic pain.
8. Patients with chronic non-cancer pain should not receive injections of opioid analgesics in the ED.
9. Physicians may consider drug screening as needed to guide treatment decisions.
10. Patients with suspected addictive behavior may be referred to detoxification resources.
Opioids by DEA Drug Schedule
The U.S. Drug Enforcement Agency classifies opioid drugs by their potential for abuse and psychological/physical dependence.
Schedule I (highest potential). Includes heroin and other illegal drugs.
Schedule II (high potential for abuse, severe dependence potential). Includes Hydromorphone (Dilaudid), Oxycodone (Percocet), Hydrocodone (Vicodin) and Fentanyl.
Schedule III (lower potential for abuse than II, still high potential psychological dependence). Includes Tylenol with codeine (Tylenol 3).
Schedule IV (lowest potential for abuse/dependence). Includes Tramadol (Ultram).