Physicians providing care in acute/urgent healthcare facilities need to respond appropriately to patients with pain and to those who are seeking drugs for misuse or diversion. An opioid-prescribing policy, which takes the local community needs into account, could serve to:
1. Provide a framework to facilitate a consistent response from all physicians. (Note: inconsistent policy application can encourage drug seekers "targeting" liberal prescribers.)
2. Act as a deterrent for individuals attempting to obtain opioids for diversion or misuse.
Patients with pain are routinely seen in acute/urgent healthcare facilities (e.g., emergency departments and walk-in clinics). Physicians assessing and treating these patients need to distinguish between pain that is acute, originating from an injury or other mechanism, or chronic. This is complicated by various scenarios:
- Some patients have chronic recurrent pain and may present in an "acute" episode of a chronic pain condition.
- Patients who are abusing or addicted to opioids or who are drug diverters may visit these settings specifically in an attempt to obtain opioids.
- Patients report they are on LTOT, have run out of their medication, are unable to access their usual care provider, and ask for a temporary prescription: they could be from another area, province, or country.
The following topics are suggested to assist physicians in creating an opioid-prescribing policy:
1. Development: Participation by all physicians providing care in the acute/urgent healthcare setting can be useful in addressing the issues and promoting adherence.
2. Policy Availability: The policy could be posted in the waiting area of the facility, and/or available as a handout, to provide patients with information in advance of seeing the physician.
3. Legislation: The policy should comply with provincial legislation about opioid prescribing, and accessing and sharing patient information.
4. Opioid Prescribing: The policy should outline circumstances for prescribing and not prescribing. For example, for patients who report they are established on opioids with another prescriber, but have run out, a policy could include requirements and limits of issuing a prescription, such as:
- Contact must be made with the prescribing physician or dispensing pharmacist.
- Number of doses prescribed is limited to last until the next business day.
- Dose is amount that the physician feels is appropriate, given the patient’s underlying pain condition, even if that dose is considerably less than what the patient reports receiving.
- The facility prescribes once only for patients who have run out.
- A record of the visit is sent to the primary-care physician.
5. Suspected Opioid Addiction: The policy could indicate a response to patients who appear addicted to opioids, e.g., provide information about addiction resources for treatment.