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Addiction Fear or Compassion Deficit? Rethinking Pain Care in the Emergency Department

by Saleena Zedan

Graphic design by Athena Li

“Can I please have more medication? I’m still in a lot of pain,” I asked my doctor in the emergency department (ED) after suffering excruciating pain from two slipped discs in my lower spine. I was denied an increased dose due to concerns about developing an opioid addiction from the ED—a prevalent issue across North America.1 Although I posed no risk for addiction, it did not matter; I had to persevere through the pain. 

My experience is not unique—up to 94% of patients report feeling dismissed across all medical settings by their physicians.2 This feeling can be especially difficult in the ED, where patients often arrive in acute pain and distress. This demonstrates how easily pain can be minimized in emergency settings and highlights the need for change in the ED that places care at the forefront.

In Canada, pain management in the ED is suboptimal. Increasingly, patients are reporting longer wait times for pain relief, often exceeding two hours after initial contact.3,4 These prolonged delays may result in limited opportunities for physicians to conduct thorough assessments with their patients. This may contribute to decisions regarding prescription of pain medication being made quickly, without fully understanding patients’ pain or risk of addiction. As a result, pain management may become shaped by quick judgements based on previous experiences with other patients rather than individualized care. 

These are not the only concerns, as research shows inequity in pain management. Older adults often wait longer in the ED for pain-relieving medication compared to younger adults.4  While 70% of ED physicians report that patient age influence their prescribing practices, the extent to which this affects actual prescribing remains unclear.5 Race and ethnicity have also been found to negatively impact pain-management and wait times in the ED.6  Specifically, patients belonging to minority groups in the ED are less likely to receive adequate pain management and more likely to endure longer wait times before assessment or treatment. A scoping review found that in 11 (91%) out of 12 studies on ED wait times, minority groups waited longer than White patients to be seen.6 Meanwhile, in terms of pain treatment, six (35%) of 17 studies found that minority groups were less likely to receive any analgesics and 11 (85%) of 13 studies found that they were less likely to receive opioids.6 Another study using data from 2013–2017 found that Black and Hispanic patients had significantly longer wait times than White patients, waiting 47-50 minutes for pain medication compared to 36-40 minutes. 7 This difference was seen even after controlling for triage level and hospital factors, once more raising concerns about delayed access to timely pain relief in the ED. Together, these findings demonstrate that inequitable pain management in the ED may be shaped by unconscious assumptions that influences patient’s care. 

Inequities in the pain management process are exacerbated by the history of opioid overprescription in the ED. Opioid overprescription in the ED began as a result of Purdue Pharma marketing the opioid oxycontin as safe and effective with little chance of developing an addiction in the 1990s.8 Consequently, between 2001-2010, prescribing opioids in the ED increased by approximately 10%.9 This history continues to influence practice today, creating a complex landscape in which physicians must balance the risk of undertreating pain with concerns about opioid-related harm. Although best practices recommend trying non-opioid options first,10 these alternatives are often limited and may be insufficient for severe pain. While new non-opioid medications such as Suzetrigine offer promise, they are not yet widely available and therefore do not meaningfully expand current ED treatment options.11,12 This lack of accessible, non-opioid treatments makes it challenging for physicians to balance two competing priorities of relieving patients’ pain while minimizing the potential for long-term opioid use. 

Recent evidence illustrates this tension: a recent study found that most ED opioid prescriptions do not lead to persistent use, although small increases in use were observed in some patients, which helps explain why healthcare providers remain careful when contemplating a prescription.13 However, at the same time, several patients in the ED still received opioid prescriptions even when they reported low pain ratings.14 Prescribing also varies widely across hospitals. A study that compared opioid prescriptions across three Canadian hospitals found that patients presenting to one ED were roughly 3.5 times more likely to be prescribed an opioid than patients at the other two, suggesting that the practices that are in place are not routinely followed across hospitals.10 These inconsistencies, paired with documented inequities in treatment, reveal how both caution and bias can shape management decisions in the ED.  

It is unclear whether there is a relationship between opioid overprescription in the ED and the current opioid epidemic in Canada. To better understand whether ED opioid prescriptions play a role in Canada’s opioid crisis, future research could investigate long-term patient outcomes or examine how hospital-level prescribing practices may affect community-level harm. Regardless if there is a link between opioid prescription and the epidemic, overprescription of opioids remains an issue if individuals are being prescribed opioids unnecessarily and their core concerns are being overlooked. 

In my case, as a young woman requesting additional medication, I may have been perceived as someone at a higher risk for opioid misuse, which resulted in the denial of the treatment I needed. My experience reflects the broader patterns described, that pain management in the ED can be influenced by assumptions. These biases contribute to the documented inequities of longer wait times, undertreatment, and limited access to non-opioid medications in the ED. Addressing these issues requires greater awareness of how these assumptions shape clinical decisions and a commitment to providing equitable pain care across patients entering the ED.

References 

  1. Canada PHA of. Opioid- and stimulant-related harms in Canada: Key findings [Internet]. 2025 [cited 2025]. Available from: https://health-infobase.canada.ca/substance-relatedharms/opioids-stimulants/ 
  2. Kennedy LP, Quimby D. What you told us about medical gaslighting [Internet]. HealthCentral; 2023 [cited 2025 Dec 6]. Available from: https://www.healthcentral.com/chronic-health/what-you-told-us-about-medical-gaslighting 
  1. Woolner V, Ahluwalia R, Lum H, et al. Improving timely analgesia administration for musculoskeletal pain in the emergency department. BMJ open quality. 2020;9(1):e000797.
  1. Mills AM, Edwards JM, Shofer FS, et al. Analgesia for older adults with abdominal or back pain in emergency department. The western journal of emergency medicine. 2011;12(1):43–50.
  1. Varney SM, Bebarta VS, Mannina LM, et al. Emergency medicine providers’ opioid prescribing practices stratified by gender, age, and years in practice. World Journal of Emergency Medicine. 2016;7(2):106. doi:10.5847/wjem.j.1920-8642.2016.02.004 
  2. Owens A, Holroyd BR, McLane P. Patient race, ethnicity, and care in the emergency department: A scoping review. Canadian journal of emergency medicine. 2020;22(2):245–53.
  3. Lu FQ, Hanchate AD, Paasche-Orlow MK. Racial/ethnic disparities in emergency department wait times in the United States, 2013–2017. The American Journal of Emergency Medicine. 2021 Sept;47:138–44. doi:10.1016/j.ajem.2021.03.051 
  4. Van Zee A. The promotion and marketing of oxycontin: commercial triumph, public health tragedy. American Journal of Public Health. 2009;99(2):221-227.
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  1. Mohiuddin AL, Ahmed Z. Suzetrigine – a novel fda‐approved analgesic – opportunities, challenges and future perspectives: A perspective review. Health Science Reports. 2025 Nov;8(11). doi:10.1002/hsr2.71545 
  2. Commissioner O of the. FDA approves novel non-opioid treatment for moderate to severe acute pain [Internet]. FDA; 2025 [cited 2025 Nov 29]. Available from: https://www.fda.gov/news-events/press-announcements/fda-approves-novel-non-opioid-treatment-moderate-severe-acute-pain 
  3. Hayward J, Rosychuk RJ, McRae AD, Sinnarajah A, Dong K, Tanguay R, et al. Effect of emergency department opioid prescribing on Health Outcomes. Canadian Medical Association Journal. 2025 Feb 9;197(5). doi:10.1503/cmaj.241542
  4. McNeil CL, Habib A, Okut H, et al. Administration and Prescription of Opioids in Emergency Departments: A Retrospective Study. Kansas journal of medicine. 2021; 14:1–4.