NEW YORK—Patients visiting any of New York City’s 11 public hospital emergency rooms (HHC) in the five boroughs will no longer be allowed to leave the hospital with an excessive number of painkillers. The policy change is the latest effort from the Mayor’s Task Force on Prescription Painkiller Abuse aimed at curbing the growing prescription drug abuse problem in the city.
Between 2008 and 2010 in New York City, prescriptions filled for oxycodone increased by 51 percent, with an average of a 10-day supply being dispensed, according to a report issued by the Mayor’s Office.
“There is a role for these drugs in medicine, but make no mistake, these are dangerous drugs,” said Health Commissioner Thomas Farley Thursday. “It is best to think of them as heroin in pill form.”
The guidelines, which were suggestions given by the city but voluntarily enforced at HHC, mean emergency departments cannot prescribe more than a three-day supply of long-lasting opioid painkillers, which include the highly addictive OxyContin, Vicodin, morphine, fentanyl patches, and methadone. Emergency room physicians will not be allowed to refill lost, stolen, or destroyed prescriptions according to the new guidelines.
It is best to think of them as heroin in pill form.
—Health Commissioner Thomas Farley
Dr. Ross Wilson, senior vice president and chief medical officer for the New York City Health and Hospitals Corporation said HHC dispenses approximately 800,000 doses of opioids per year. He hopes the guidelines will not only reduce the number of doses dispensed, but also the number of doses per prescription.
Wilson gave assurances that the guidelines will not prevent doctors from helping manage patients’ pain. He gave the example of a broken bone, a common reason for an emergency room visit. A patient will likely need more than three days of pain medication in that instance, but it will not be up to the emergency room doctor to provide that. They will be referred to a specialist to continue the care and pain management.
“What we don’t want to do is to predict someone will need 20 days of pain relief for something that may just take two days. If they need 20 days, they need more care from somewhere else,” Wilson said. “These guidelines will not lead to patients failing to receive the pain relief they need.”
Prior to the guidelines, emergency room physicians were left to guess if a patient was addicted and looking to get a fix, or in real pain.
“That is the very difficult part of practicing medicine. Pain is so subjective. You don’t know,” said Dr. Lewis Nelson, professor of emergency medicine at the New York University School of Medicine.
These new measures grow on the broader clinical guidelines the city released in December 2011. Using these guidelines, Community Healthcare Network (CHN), a nonprofit community-based health system that provides services for the underserved, adopted their own internal method for dispensing pain medication.
CHN limits its pain medication to three-day supplies, and also offers alternatives for treating pain, such as physical therapy, acupuncture, and stretching. These guidelines are explained to the patient before treatment, so expectations are set.
“It helps a lot because if anything happens down the road, we can say we had that conversation,” said Dr. Matthew Weissman, chief medical officer of CHN. “Because the expectations are set up front, the providers can all point to guidelines. I think the patients are very receptive to that,” Weissman said.
Weissman also said it prevents “doctor shopping” because all 65 of their providers adhere to the same guidelines.
“I think this is a very positive step forward in terms of curbing abuse but still recognizing the importance of pain control among our patients, and parallels nicely the kind of efforts CHN has taken with our own policies and our own patients,” said Weissman.
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