Table 3.

Washington ED Opioid Prescribing Guidelines (abbreviated)

Washington ED Opioid Prescribing Guidelines
1. One medical provider should provide all opioids to treat a patient's chronic pain
2. The administration of intravenous and intramuscular opioids in the ED for the relief of acute exacerbations of chronic pain is discouraged
3. Emergency medical providers should not provide replacement prescriptions for controlled substances that were lost, destroyed, or stolen
4. Emergency medical providers should not provide replacement doses of methadone for patients in a methadone treatment program
5. Long-acting or controlled-release opioids (such as OxyContin®, fentanyl patches, and methadone) should not be prescribed from the ED
6. EDs are encouraged to share the ED visit history of patients with other emergency physicians who are treating the patient using an Emergency Department Information Exchange (EDIE) system
7. Physicians should send patient pain agreements to local EDs and work to include a plan for pain treatment in the ED
8. Prescriptions for controlled substances from the ED should state that the patient is required to provide a government-issued picture identification (ID) to the pharmacy filling the prescription
9. EDs are encouraged to photograph patients who present for pain-related complaints without a government-issued photo ID
10. EDs should coordinate the care of patients who frequently visit the ED using an ED care coordination program
11. EDs should maintain a list of clinics that provide primary care for patients of all payer types
12. EDs should perform screening, brief interventions, and treatment referrals for patients with suspected prescription opioid abuse problems
13. The administration of Demerol® (meperidine) in the ED is discouraged
14. For exacerbations of chronic pain, the emergency medical provider should contact the patient's primary opioid prescriber or pharmacy. The emergency medical provider should only prescribe enough pills to last until the office of the patient's primary opioid prescriber opens
15. Prescriptions for opioid pain medication from the ED for acute injuries, such as fractured bones, in most cases should not exceed 30 pills
16. ED patients should be screened for substance abuse prior to prescribing opioid medication for acute pain
17. The emergency physician is required by law to evaluate an ED patient who reports pain. The law allows the emergency physician to use their clinical judgment when treating pain and does not require the use of opioids