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Opioid Guidelines for ER Docs Help, But More Study Needed

FRIDAY, March 8 (HealthDay News) -- Local recommendations like those recently released in New York City aimed at improving opioid prescribing are good first steps but unlikely on their own to address the full problem, according to a viewpoint published in the March 6 issue of the Journal of the American Medical Association.

David N. Juurlink, M.D., Ph.D., from University of Toronto, and colleagues assessed New York City guidelines developed to improve opioid prescribing among emergency room physicians. The guidelines were developed by a panel of emergency physicians and announced by Mayor Michael Bloomberg in January with the intention of reducing opioid addiction and overdose deaths while preserving access to opioids for patients who need them.

The researchers found that many factors contribute to morbidity and mortality associated with opioid prescriptions. First, the authors point to evidence that for most conditions, opioids are likely no more effective than other therapies physicians could recommend. Regulatory approval of prescription opioid products is based on studies in which they were compared with placebo, a treatment no clinician would prescribe for pain. Second, there is an under-appreciation of the risks of opioid dependence and addiction, with up to one-third of patients receiving chronic opioid therapy meeting criteria for an opioid use disorder. Third, prescriptions are often made for a larger supply of opioids than necessary and sometimes initiate therapy with extended-release formulations in situations, like for acute pain, where short-acting preparations would be preferred.

"Emergency department prescribing of opioid medications is not the cause of the opioid epidemic, but these guidelines and others are important first steps toward addressing this public health problem," the authors write.

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