It's not the first time the industry has taken a hard line approach to curtailing prescription drug abuse. Mercy Medical Center in Des Moines, IA, has posted signs in its ED saying it would only prescribe pain medication for emergency medical conditions.
It's directed at patients who think they will get easy access to prescription painkillers in the ED. Ohio has adopted similar guidelines, but its ED pain plan asks that doctors to use the prescription monitoring database to see the presenting patient's prescription history, and, among other things, to refer the patient to a nearby pain management facility.
"As far as pain management in the ER goes, I think this is right on the money," says AAPM's Twillman. He worries that the patients who genuinely have chronic pain are forgotten about.
"I think some primary care doctors are looking at not prescribing anything, and that's a problem. Then the patient is left with no care and they end up in the emergency room," he says.
A turning point in painkiller abuse could be mandatory pain management training for physicians. ASIPP's David Kloth, MD, says the group lobbied hard for a mandatory 8-hour training course for all primary care physicians last year, but the legislative proposal failed.
"We teach this course all the time. We can divide it up into one-hour lectures on the web. There is a way to educate physicians on the use of these controlled substances."