Today the United States Centre for Disease Control issued an early release of an article to be published in it’s Morbidity and Mortality Weekly Review (MMWR). The title is Vital Signs: Overdoses of Prescription Opioid Pain Relievers – United States 1999 – 2008, and the content is startling. Overdose deaths due to prescription opioid pain relievers are almost as common as deaths due to motor vehicle collision (36,450 vs 39,973 for 2008).
You heard correctly, your cause of death is now equally likely to be from either a motor vehicle collision or an overdose of prescribed narcotics. If you worry about dangerous drivers on the roads, you should also worry about dangerous prescribers in the hospital.
In the emergency room we are faced with a difficult dilema, confronted with acute pain, but uncertain of risk to the patient when we prescribe narcotic pills. This is risky business. My own feeling is that we should be very aggressive about the control of acute pain within our departments. When we send patients home with narcotic pain pills we should send them with a very small supply, and instructions for close follow-up with a provider they know who can follow them along over time.
There are ways to assess the risk to patients when they commence on opioid medications. Dr. Douglas Gourlay’s paper Universal Precautions in Pain Control is a must read for anyone who ever writes for opioid medications. However, with even the best of training and the best of intentions our interactions with patients in the emergency department are fleeting. We have no capacity to follow patients along, to assess their risk and response over time. As prescribers of opioids medications pills that flowed from our pen have killed people. We must be cognizant of this, reduce the risk for our patients and confine our prescribing to agressive relief of acute pain within our department, and short bridging therapy until the patient can be reassessed by their own family physician. To do otherwise exposes our patient to unacceptable risk.