Emergency physicians believe we can identify people coming to the ED for addiction or diversion, but this is not true. In a case-controlled study, 21 percent of patients requesting analgesia and 13 percent of controls tested positive for drug addiction using the DAST-20 survey (of those who agreed to participate). There was no correlation between the pain score and the DAST score. Almost one-half of patients scoring positive for addiction had a history of multiple ED visits and requests for specific opiates or “allergies” to opiates—but more than half did not. (California J EM. 2005;6:3-8). This inability to identify such patients usually results in labeling all patients seeking pain relief or requesting analgesics as “opioid seekers” for diversion rather than people suffering from inadequate pain management.
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ACEP Now: Vol 33 – No 03 – March 2014In my next column, I will discuss standardizing the ED approach to patients seeking opioids.
Jim Ducharme, MD, CM, FRCP, is editor in chief of the Canadian Journal of Emergency Medicine, clinical professor of medicine at McMaster University, and chief medical officer of McKesson Canada.
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