Missouri doctors urge new limits on prescribing opioids in hospitals | St. Louis Public Radio

Missouri doctors urge new limits on prescribing opioids in hospitals

Dec 4, 2018

A coalition of six medical organizations has recommended that hospital doctors take more caution when prescribing opioids for patients with pain.

To cut down on unnecessary prescriptions of addictive painkillers, the Missouri College of Emergency Physicians, the Missouri Hospital Association and other groups want hospital doctors to limit prescriptions, in some cases to a week's supply.

The guidelines, which update a 2015 list that applied only to emergency departments, now include all hospital personnel who prescribe medicine.

“I think three years ago physicians understood at that time we played a role in all this,” said Evan Schwarz, president of the state’s college of emergency physicians, referring to the unprecedented number of people addicted to and dying from opioids. “It’s our responsibility to limit exposure when we can.”

Public health experts have pointed to physicians’ liberal prescribing of opioids such as OxyContin as one of the drivers of the opioid epidemic, which killed 760 people in the St. Louis region last year. Doctors have been trying to course-correct by prescribing fewer pills at a time and prescribing non-opioid painkillers such as topical creams and heavy-duty ibuprofen.

The new guidelines made slight changes to the original list from three years ago. In addtion to the week-long limit, the revised guidelines recommend doctors provide the opioid-reversal drug naloxone to patients they consider at risk for an overdose.

Other guidelines include warnings against using long-acting forms of opioids and endorsing non-narcotic treatment of chronic dental problems such as toothaches.

It was important to extend the guidelines to hospitals, Missouri Hospital Association spokesman Dave Dillon said. Many times emergency room patients are moved to a hospital inpatient room after treatment, he said.

“We wanted to ensure all the individuals who were potentially prescribed opioids had the same type of standard thinking for the clinician that would be prescribing at discharge,” Dillon said.

The guidelines are different from hard requirements, said Schwarz, who helped write the new recommendations. If a doctor thinks a person’s pain constitutes a larger prescription, they are free to make that call.

“These guidelines aren’t meant to advocate for illegal analgesia or for undertreating pain,” Schwarz said. “It’s to make sure we’re prescribing responsibly, but providing for physician judgment to do what they think is best for the patient.”

Most physicians already have become more judicious when prescribing opioids, he said. However, the rules can help justify those decisions.

“If you’re the physician and you just don’t believe prescribing someone an opioid is a good idea or believe that you only need to give them two or three days, if you don’t have support, you can feel like you’re on an island,” Schwarz said. “And sometimes that can make the interaction with the patient more difficult.”

The Missouri Dental Association, The Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons and the Missouri Academy of Family Physicians also contributed to the new guidelines.

Follow Sarah on Twitter: @Petit_Smudge