Opiate misuse is everywhere.

Approximately 15-20% of ED patients in the US are prescribed outpatient opiates upon discharge. In Ontario, about 10 people die accidentally from prescription opiates every week. Between 1990 and 2010, drug overdose deaths in the US increased by almost four fold, eclipsing the rate of death from motor vehicle collisions in 2009. This was driven by deaths related to prescription opiates, which now kill more people than heroin and cocaine combined. Opiates are the most prescribed class of medication in the US. In 2010, one out of every eight deaths among persons aged 25 to 34 years was opiate-related. Four out of 5 new heroin users report that their initial drug was a prescription opiate. In Ontario, three times the people died from opiate overdose than from HIV in 2011.

Yet, we are expected to treat pain aggressively in the ED.

Dr. Reuben Strayer, the brains behind the fantastic blog EM Updates tells his Best Case Ever, in which he realizes the importance of physician compassion in emergency management of pediatric seizuresapproaching the challenging drug seekers and malingerers that we manage in the ED on a regular basis.


This Best Case Ever is in anticipation of an upcoming main episode in which Dr. Strayer and toxicologist Dr. David Juurlink discuss how to strike a balance between managing pain effectively and providing the seed for perpetuating a drug addiction or feeding a pre-existing drug addiction, and how we best take care of our patients who we suspect might have a drug misuse problem.

Published October, 2015

The Opiod Risk Tool

opiod risk toolReferences

Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6(6):432-42.

Baumblatt JA, et al. High-risk use by patients prescribed opioids for pain and its role in overdose deaths. JAMA Intern Med. 2014 May;174(5):796-801.

Bridget M, Kuehn MSJ. SAMHSA: Pain Medication Abuse a Common Path to Heroin Experts Say This Pattern Likely Driving Heroin Resurgence. JAMA. 2013;310(14):1433-1434.

FOAMed Resources

Dr. Mike Evans’ video on Best Advice for People Taking Opiod Medications

Reuben Strayer’s take home points from his talk at SMACC Chicago 2015 on EM Updates

Dr. Helman & Dr. Strayer have no conflicts of interest to declare