Emergency Medicine Oversight Commission
San Diego County Medical Society
Narcotic Prescription Guidelines
The Emergency Medicine Oversight Commission of the San Diego County Medical Society Narcotic
Prescription Guideline is written with cooperation of the San Diego Field Office of the Drug Enforcement
Administration with the purpose of reducing pharmaceutical drug diversion without affecting legitimate
medical practice and patient care.
This guideline can be used to empower practitioners to deny narcotic prescriptions to emergency
department patients who meet stated criteria. The guideline does not affect the treatment for acute pain
in the emergency department, only written prescriptions.
The individual practitioner’s medical judgment and assessment of individual cases supersede these
guidelines. NARCOTIC PRESCRIPTIONS GUIDELINES
1. Patients who have established chronic pain conditions and have a
medical home should not receive narcotic prescriptions from the
emergency department and are encouraged to obtain any new
prescriptions or refills by their physician or clinic.
2. Patient who received a recent prescription for narcotics as determined
by the hospitals medical records, health plan records, or by CURES
database should not receive repeat narcotic prescription from the
emergency department for the same medical condition. Repeat
prescriptions should be obtained by their medical follow up physician or
POTENTIAL INDICATORS FOR PRESCRIPTION DRUG ABSUE AND FRAUD
Patient requesting specific controlled substances
Repeatedly running out of medication early
Unwillingness to try non-opioid treatments Engaging in doctor shopping activities Complaining of medical condition with lack of pathology
PATIENTS WITH FREQUENT ED VISITS FOR PAIN
1. Give referral for pain specialists or make sure they have a medical home 2. Devise Pain Management Contract with patient
All acute pain management is at the discretion of the treating emergency physician. Care Plans, or Pain contracts can include amount of pain medication allowed in the ED with specific frequency. For example: Patient X can obtain acute ED treatment for migraine headaches with Dilaudid 1 mg IM up to 2 doses with Phenergan 25 mg IV no more than every 4 weeks.
3. Do not write narcotic prescriptions, but refer all narcotic prescription needs to
4. Attempt PO pain medication instead of IM or IV when possible
WHAT TO DO ABOUT SUSPECTED NARCOTIC FRAUD?
Call DEA Diversion: 858-616-4100
Email to DEA: [email protected]
It is helpful for DEA if you document the following in your dictation:
When patient states he last received prescription for narcotics
It is also helpful to have a copy of the patient’s ID card.
Patient who lie about when their last prescription was filled are guilty of
For patients who are argumentative, you can agree to write prescription,
write for a small amount, document interaction, and then call the DEA.
The state’s database known as the Controlled Substance Utilization Review
and Evaluation System, C.U.R.E.S. To Obtain Access to the California Prescription Drug Monitoring Program, PDMP System, you must submit registration electronically at https://pmp.doj.ca.gov/pmpreg/RegistrationType_input.action
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