I don't know how many ER's there are like that any more -- most of them seem to be responding more to administrative edicts to keep the customers happy, rather than evidence based medical guidelines.
Our ER is likely to give you a blast of IV dilaudid the minute you hit the door. They have very happy customers.
Years ago (say 1960-1975) Oregon was notorious for the number of Percocets prescribed (mind you, these were Percocet-5!) and there was a Draconian crackdown about 1975. For the next 20 years it was pretty much risking your license to prescribe a Tylenol-3 once a day for an arthritis flare if you prescribed for more than 30 days.
That all changed about 1995-2000 with Pain the Fifth Vital Sign, and a rather problematic distinction being made between dependency and addiction. "People in chronic pain don't become addicted to drugs even if they are dependent on them". Pain clinics erupted, and pharmaceutical houses made mountains of cash on narcotic pain relievers.
Now, we're in another backlash.
I have a few patients who genuinely benefit from chronic high dose narcotics for intractable, non-malignant pain.
I have difficulty with a larger group who really shouldn't be taking them, but got started on them, and now don't believe they can stop.
