Analgesia and Addiction in Emergency Department Patients with Acute Pain Exacerbations

INTRODUCTION There is ongoing controversy regarding the appropriate use of narcotic analgesia for patients presenting frequently to the emergency department (ED) with subjective acute exacerbations of pain. "Are we treating pain or enabling addiction?" OBJECTIVES To determine whether the presence of specific factors could be used to identify adults complaining of acute exacerbations of pain for suspected drug addiction, to estimate the percentage of drag addicted patients, to assess the physicians' ability to detect drug addiction and to evaluate Interrater reliability. METHODS A Drug Abuse Screening Test (DAST-20) was administered to 76 ED patients who presented with acute exacerbations of pain and either multiple ED visits for similar pain complaints, specific narcotic requests, or "allergies" to non-narcotics. The DAST-20 was also administered to 74 age-matched controls. Treating ED physicians rated their suspicion for drug addiction using a visual analog scale (VAS). RESULTS The overall estimation of drug addiction based on the DAST-20 survey was 17.3% (26/150). Twenty-one percent (16/76) of the analgesia subjects and 13.5% (10/74) of the control subjects scored positive for drug addiction as measured by the DAST-20. Of the analgesia subjects with positive DAST-20 scores for drug addiction, 43.8% (7/16) had multiple ED visits, 43.8% (7/16) requested specific narcotics and 6.3% (1/16) reported "allergies" to non-narcotics. There was no correlation between the VAS scores and the DAST-20 scores. There was a significant correlation between resident and attending VAS scores for their suspicion for drug addiction. CONCLUSION There exists a clinically significant drug addiction problem among ED patients presenting with acute exacerbations of pain and among low-acuity patients who do not present to the ED for pain management.