Scope of Application This guideline is intended for physicians working in emergency departments. Inclusion Criteria This guideline is intended for adult patients presenting in unscheduled acute care settings.
Exclusion Criteria/b> This guideline is not intended for use with pediatric patients.
Critical Questions
In adult patients experiencing opioid withdrawal, is emergency department-administered buprenorphine as effective for the management of opioid withdrawal compared with alternative management strategies?
Level B Recommendation:
When possible, treat opioid withdrawal in the emergency department with buprenorphine or methadone as a more effective option compared with nonopioid-based management strategies such as the combination of α2-adrenergic agonists and antiemetics.
Level C Recommendation:
Preferentially treat opioid withdrawal in the emergency department with buprenorphine rather than methadone.
In adult patients experiencing an acute painful condition, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms?
Level C Recommendations:
Preferentially prescribe nonopioid analgesic therapies (nonpharmacologic and pharmacologic) rather than opioids as the initial treatment of acute pain in patients discharged from the emergency department.
For cases in which opioid medications are deemed necessary, prescribe the lowest effective dose of a short-acting opioid for the shortest time indicated.
In adult patients with an acute exacerbation of noncancer chronic pain, do the benefits of prescribing a short course of opioids on discharge from the emergency department outweigh the potential harms?
Level C Recommendations:
Do not routinely prescribe opioids to treat an acute exacerbation of noncancer chronic pain for patients discharged from the emergency department. Nonopioid analgesic therapies (nonpharmacologic and pharmacologic) should be used preferentially.
For cases in which opioid medications are deemed appropriate, prescribe the lowest indicated dose of a short-acting opioid for the shortest time that is feasible.
In adult patients with an acute episode of pain being discharged from the emergency department, do the harms of a short concomitant course of opioids and muscle relaxants/sedative-hypnotics outweigh the benefits?
Level C Recommendation:
Do not routinely prescribe, or knowingly cause to be co-prescribed, a simultaneous course of opioids and benzodiazepines (as well as other muscle relaxants/sedative-hypnotics) for treatment of an acute episode of pain in patients discharged from the emergency department (Consensus recommendation).
Disclaimer Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician's judgment and patient preferences.
