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Jan 10, 2013 Comments Off Spit Stixx

Excerpted from The New York Times: Some of the most common and most powerful prescription painkillers on the market will be restricted sharply in the emergency rooms at New York City’s 11 public hospitals, Mayor Michael R. Bloomberg said Thursday in an effort to crack down on what he called a citywide and national epidemic of prescription drug abuse.

Under the new city policy, most public hospital patients will no longer be able to get more than three days’ worth of narcotic painkillers like Vicodin and Percocet. Long-acting painkillers, including OxyContin, a familiar remedy for chronic backache and arthritis, as well as Fentanyl patches and methadone, will not be dispensed at all. And lost, stolen or destroyed prescriptions will not be refilled.

City officials said the policy was aimed at reducing the growing dependency on painkillers and preventing excess amounts of drugs from being taken out of medicine chests and sold on the street or abused by teenagers and others who want to get high.

“Abuse of prescription painkillers in our city has increased alarmingly,” Mr. Bloomberg said in announcing the new policy at Elmhurst Hospital Center, a public hospital in Queens. Over 250,000 New Yorkers over age 12 are abusing prescription painkillers, he said, leading to rising hospital admissions for overdoses and deaths, Medicare fraud by doctors who write false prescriptions and violent crime like “holdups at neighborhood pharmacies.”

But some critics said that poor and uninsured patients sometimes used the emergency room as their primary source of medical care. The restrictions, they said, could deprive doctors in the public hospital system — whose mission it is to treat poor people — of the flexibility that they need to respond to patients.

“Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians and senior vice chairman of emergency medicine at Lehigh Valley Health Network in Eastern Pennsylvania. “It prevents me from being a professional and using my judgment.”

While someone could fake a toothache to get painkillers, he said, another patient might have legitimate pain and not be able to get an appointment at a dental clinic for days. Or, he said, a patient with a hand injury may need more than three days of pain relief until the swelling goes down and an operation could be scheduled.

Dr. Rosenau said that the college of emergency physicians had not developed an official position on the prescribing of painkillers in emergency rooms and that he appreciated Mr. Bloomberg’s activism in the face of a serious public health problem. But he said pain clinics in states like Florida and California, states where prescription drug abuse is rampant, as well as the household medicine cabinet, were probably a more common source of unneeded painkillers than emergency rooms.

City health officials said the guidelines would not apply to patients who need prescriptions for cancer pain or palliative care, and drugs would still be available outside the emergency room. They said that in this era of patient-satisfaction surveys, doctors were often afraid to make patients unhappy by refusing drugs when they are requested, and the rules would give those doctors some support when they suspected that a patient might be faking pain to get drugs.

“There will be no chance that the patients who need pain relief will not get pain relief,” said Dr. Ross Wilson, senior vice president and chief medical officer of the Health and Hospitals Corporation, which runs the city’s public hospitals.

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