Do we as physicians prescribe too many narcotics? Specifically do we emergency physicians prescribe more than we should? As with much else in medicine the evidence is complex and at times contradictory. Some examples of the argument that we are not aggressive enough in the treatment of pain are the following (click on them to access links):
- Racial and ethnic disparities in pain management
- Under treatment of acute pain in the emergency department
- Under treatment of pain in elderly leads to opioid misuse
- CMS to measure timing of ED pain medication in long bone fractures
If you have spent any time looking at the news or proposed state legislation the answer would clearly be yes. There is an epidemic of deaths related to prescription drug use and misuse. The problem is stark both in terms of the individual tragedies and sheer numbers.
The CDC has some great graphics that…
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Anatomy of a Super ER 
Dave,
I enjoyed this. I forwarded it on to the ED medical director here for his reading enjoyment. ☺
Hope you’re doing well,
David J. Gast, NREMT-P
Paramedic Coordinator
Emergency Services
Chandler Regional Medical Center
A Dignity Health Member
1955 W Frye Rd.
Chandler, AZ 85224
480.728.3206 (O)
480.415.3162 (M)
602.294.5905 (F)
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Very good piece Dave! Another entire part to this problem is that there is absolutely NO regulation at the pharmacies as to who picks up the prescription. An example: I picked up a friend from same day surgery this week, and brought her home. I then went to the pharmacy with her prescription for vicoden (in her name from her doc) and had ZERO problem dropping it off AND picking it up for her – I even asked about it, and they didn’t bat an eye. Yes, it was very convenient for my friend and I, but the opportunity for abuse is VERY high here.
Another scenario is where people get the doctor’s information from legitimate scripts (all of our numbers are on these papers and easily accessible to anyone who sees them), and with one prescription pad can write for whatever they want using different pharmacies and different made up patient names. Also I have heard of “stripping” prescriptions – where they take a real script and strip it of ink and then write whatever they want.
That last part about fraudulent prescriptions worries me greatly. I do think that periodically looking at the Self-Lookup is a good tool to identify if that is happening (like checking your credit rating 🙂