ER "Toothache" Pain 'Scripts Surge
Too many patients and too little time give ER doctors trouble deciding who needs meds and who just wants them.
Dental patients in emergency rooms are fairly common, and with a new report from the National Institutes of Health showing that painkiller prescriptions for dental patients increased 26% in ER visits between 1997-2007, doctors now face a huge challenge: determining which dental patients complain of tooth pain as a ruse to get narcotics. According to a new analysis of the National Hospital Ambulatory Medical Care Survey, painkillers were prescribed in three out of four visits to the emergency department for dental complaints during the survey period. “The overuse of narcotics is a huge problem, and when a patient presents, especially for dental pain, it’s difficult to make an objective assessment,” says Dr. Gail D'Onofrio, chairwoman of the emergency medicine department at Yale School of Medicine. “It puts the physician in a difficult situation to assess whether or not someone truly needs pain medications. We err on the side of treating pain, and it is a huge potential for abuse.” Doctors also say time pressures and heavy patient loads prevent them from using state drug monitoring programs to see whether a patient has recently received painkillers. But some states are looking into ways to crack down on this problem. Ohio Governor John Kasich announced guidelines on Monday to limit the number of pills ER doctors can prescribe—including no longer prescribing painkillers to patients seeking treatment for chronic pain, and limiting prescriptions to a three-day window.