What are the guidelines for opioid (narcotic pain medication) refills in the emergency room (ER) in Oklahoma?

Oklahoma Laws Regarding Opioid Refills in the Emergency Room

Emergency departments in Oklahoma should not refill opioid prescriptions for chronic pain management, as the ER is not an appropriate setting for continued opioid therapy. 1

Legal and Clinical Framework

The CDC guidelines provide clear direction regarding opioid prescribing in emergency settings:

• Emergency departments should focus on treating acute pain only, not providing refills for chronic pain management
• When opioids are prescribed for acute pain in the ER, they should be:
  • Immediate-release formulations only (never extended-release/long-acting opioids) 1
  • Lowest effective dose 1
  • Limited quantity (3 days or less is often sufficient; more than 7 days will rarely be needed) 1

Specific Guidance for ER Physicians

For Acute Pain Management

1. Use non-opioid therapies when possible
2. If opioids are necessary:
   • Prescribe immediate-release formulations only 1
   • Start with the lowest effective dose (typically 5-10 MME per dose or 20-30 MME/day) 1
   • Prescribe only the quantity needed for expected duration of severe pain 1
   • Avoid prescribing "just in case" extra doses 1

For Patients Seeking Refills

• ER physicians should not refill prescriptions for chronic pain management
• Patients should be referred to their primary care provider or pain specialist for ongoing pain management
• ER physicians should consider checking the state Prescription Drug Monitoring Program before prescribing any opioids

Common Pitfalls to Avoid

1. Inappropriate refills: The emergency department is not designed for ongoing pain management and should not be used as a source for opioid refills 1

2. Extended-release formulations: ER/LA opioids should never be prescribed in the emergency department setting 1

3. Excessive quantities: Prescribing more than a 3-7 day supply from the ER increases risk of long-term use and potential misuse 1

4. High-dose prescriptions: Higher doses correlate with increased risk of adverse events, including overdose and death 2

Special Considerations

• For patients who have legitimate chronic pain needs but lack access to regular care, the ER physician should:

  • Provide only a minimal bridge supply (if any)
  • Make appropriate referrals to primary care or pain management
  • Document the exceptional circumstances warranting any opioid prescription

• For patients showing signs of opioid use disorder, consider referral to addiction treatment services rather than providing opioid refills

The CDC guidelines emphasize that long-term opioid use often begins with treatment of acute pain 1, highlighting the critical role emergency departments play in preventing inappropriate long-term opioid use through adherence to these prescribing limitations.