Emergency physician attitudes and management strategies toward chronic pain and “drug-seeking behavior”: A survey of emergency physicians

Prescription drug abuse and diversion are highly prevalent in the United States. The use of Emergency Departments (EDs) to acquire prescription narcotic medications for abuse is a serious concern among emergency physicians (EPs) and their clinical experiences are meaningful and instructive. 

We performed a cross-sectional survey study of EPs working for a large integrated delivery system in Northern California. Questions were designed to evaluate EP attitudes as well as management principles used for these complicated patients. 

In total, 393 physicians completed the online survey (response rate 65.8%). We found the majority of EPs surveyed do not believe that chronic pain is an emergency condition (88.3%).  Additionally, they feel drug-seeking behavior (DSB) diverts resources from patients with more serious conditions (90.9%). The electronic health record (EHR) is seen as an effective tool when managing DSB patients (95.9% agreed). A minority of physicians (17.9%) report that they “always” document DSB and many more (79.8%) “usually” or “sometimes” document it. Although the use of prescription drug history in the California Prescription Drug Monitoring Program is viewed positively, it is underutilized by many EPs (39.5% did not have access).

Our results highlight particular EP attitudes regarding DSB, documentation strategies, and access to controlled substance history information at the point of care.  Although the majority of EPs report that they “usually” document DSB, it is concerning that a minority are hesitant. Better ED guidelines regarding DSB documentation might help improve the use of EHRs and dispel concerns about placing this information in the medical record.