Prescription opioid abuse in the emergency department

Patients in pain who seek opioids in the Emergency Department (ED) may appear to be doctor shopping. But such presentations must never exclusively be taken as evidence of aberrant behavior in a patient seeking to obtain opioids in an ED. Emergency physicians are challenged to reserve judgment even when presented with a patient who seems to have drug-seeking behavior, as this impression may be false. Sometimes, there are no other providers available and patients must attempt to find care in the ED as a "last resort." Since there is rarely a single behavior or event that confirms the diagnosis of addiction in a chronic pain patient, the diagnosis usually remains elusive in the ED setting. In order to help ED physicians find a more tangible method for assessing the potential for opioid misuse in the ED, new screening tools are currently being developed. In addition, legislative initiatives and technological advances in the form of prescription monitoring databases may someday make it feasible for an ED physician to screen patients for evidence of multiple providers.