New York City to Restrict Prescription Painkillers in Public Hospitals’ Emergency Rooms

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**Frazzled**

Evidently Bloomberg is a doctor now too.

http://www.nytimes.com/2013/01/11/nyregion/new-york-city-to-restrict-powerful-prescription-drugs-in-public-hospitals-emergency-rooms.html?hp&_r=1&

New York City to Restrict Prescription Painkillers in Public Hospitals’ Emergency Rooms Ozier Muhammad/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.

Similar rules have been adopted in Washington State and Utah. Dr. Thomas A. Farley, the city’s health commissioner, said opioid painkillers were not much different from highly addictive and more taboo street drugs like heroin. He called them “heroin in pill form.”

More than two million prescriptions for opioid painkillers are written in New York City each year, the equivalent of a quarter of the city’s population, Dr. Farley said, and about 40,000 New Yorkers are already dependent on painkillers and need treatment. Painkillers were involved in 173 accidental overdose deaths in New York City in 2010, a 30 percent rise from five years earlier.

Officials could not say how many prescriptions were written at emergency rooms. Libby Holman, a spokeswoman for Purdue Pharma, which manufactures OxyContin, declined to comment.

Dr. Farley said the city lacked the regulatory authority to impose the new guidelines on its 50 or so private hospitals. But several private hospitals, including NYU Langone Medical Center in Manhattan and Maimonides Medical Center in Brooklyn, said they would adopt them voluntarily.

Dr. Hillary Cohen, medical director of emergency medicine at Maimonides, said that even now, OxyContin was rarely prescribed in the emergency room.

**d-usa**

Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

**Seaward**

While I think this particular example is a non-issue, I do believe you have to admire Bloomberg's firm commitment to ensuring no one ever utters the words, "They hate us for our freedom!" about his town again.

**AustonT**

Dr. Hillary Cohen, medical director of emergency medicine at Maimonides.

Must be a catholic hospital.

**whembly**

d-usa wrote:
Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

Ditto... the ED is loaded with stories where patient coming in complaining about pain... when everyone knows they're looking for a quick fix.

**Dreadwinter**

whembly wrote:
d-usa wrote:
Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

Ditto... the ED is loaded with stories where patient coming in complaining about pain... when everyone knows they're looking for a quick fix.

Yeah! So we should punish everybody for those silly addicts!

I do not know about NY, maybe they have some sort of epidemic, but the hospital I work at does not have a lot of drug seeking behavior.

**azazel the cat**

Dreadwinter wrote:
whembly wrote:
d-usa wrote:
Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

Ditto... the ED is loaded with stories where patient coming in complaining about pain... when everyone knows they're looking for a quick fix.

Yeah! So we should punish everybody for those silly addicts!

I do not know about NY, maybe they have some sort of epidemic, but the hospital I work at does not have a lot of drug seeking behavior.

I guess you work in one of these types of hospitals, then?

Spoiler:

**Frazzled**

Thats quality.

**Dreadwinter**

I wish, I bet the service there is phenomenal. What is that, 1:1 patient ratio?

**Piston Honda**

Dreadwinter wrote:
whembly wrote:
d-usa wrote:
Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

Ditto... the ED is loaded with stories where patient coming in complaining about pain... when everyone knows they're looking for a quick fix.

Yeah! So we should punish everybody for those silly addicts!

I do not know about NY, maybe they have some sort of epidemic, but the hospital I work at does not have a lot of drug seeking behavior.

There are many people trying to get quick fixes from drugs in major cities. NY, Philly, Chicago, Boston, Detroit being someone of the places I personally know which happens a lot. oxycontin is huge in Boston and Detroit.

**whembly**

Piston Honda wrote:
Dreadwinter wrote:
whembly wrote:
d-usa wrote:
Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

Ditto... the ED is loaded with stories where patient coming in complaining about pain... when everyone knows they're looking for a quick fix.

Yeah! So we should punish everybody for those silly addicts!

I do not know about NY, maybe they have some sort of epidemic, but the hospital I work at does not have a lot of drug seeking behavior.

There are many people trying to get quick fixes from drugs in major cities. NY, Philly, Chicago, Boston, Detroit being someone of the places I personally know which happens a lot. oxycontin is huge in Boston and Detroit.

Yeah... what's sad is that these junkies are making it difficult for patients in real pain to legitimately acquire these pain meds....

**KalashnikovMarine**

Man why would any one live in NYC?

High taxes, psychotic rent, you can't even get a large soda from 7-11 and now once you inevitably get mugged the ER can't give you pain killers to help with the beating you just received along with the theft of your wallet and cellphone.

**Dreadwinter**

KalashnikovMarine wrote:
Man why would any one live in NYC?

High taxes, psychotic rent, you can't even get a large soda from 7-11 and now once you inevitably get mugged the ER can't give you pain killers to help with the beating you just received along with the theft of your wallet and cellphone.

Hey man, they do not know if you beat yourself up just to get drugs or not. They cannot take that risk.

**dogma**

KalashnikovMarine wrote:
Man why would any one live in NYC?

Probably because the nightlife is amazing, the atmosphere is cosmopolitan to a degree that is unmatched in the US, its a center of international business, and one of most important places in the world in terms of art and culture.

I would move to New York in a heartbeat.

**d-usa**

Dreadwinter wrote:
KalashnikovMarine wrote:
Man why would any one live in NYC?

High taxes, psychotic rent, you can't even get a large soda from 7-11 and now once you inevitably get mugged the ER can't give you pain killers to help with the beating you just received along with the theft of your wallet and cellphone.

Hey man, they do not know if you beat yourself up just to get drugs or not. They cannot take that risk.

You must work in a paradise hospital if you have never seen that happen.

**KalashnikovMarine**

It's also a giant festering sewer, so I suppose there's that. Come to New York for the culture, stay for the rats the size of a standard poodle!

(and yes I have been there. This only confirmed my opinion that it's a hell hole.)

**Cheesecat**

KalashnikovMarine wrote:
It's also a giant festering sewer, so I suppose there's that. Come to New York for the culture, stay for the rats the size of a standard poodle!

(and yes I have been there. This only confirmed my opinion that it's a hell hole.)

Also traffic.

**KalashnikovMarine**

Well if you're sane you don't own a car in New York City from what I understand. I certainly wouldn't from my visit.

**Cheesecat**

KalashnikovMarine wrote:
Well if you're sane you don't own a car in New York City from what I understand. I certainly wouldn't from my visit.

Don't most people take taxis? Wouldn't the train be better?

**Dreadwinter**

d-usa wrote:
Dreadwinter wrote:
KalashnikovMarine wrote:
Man why would any one live in NYC?

High taxes, psychotic rent, you can't even get a large soda from 7-11 and now once you inevitably get mugged the ER can't give you pain killers to help with the beating you just received along with the theft of your wallet and cellphone.

Hey man, they do not know if you beat yourself up just to get drugs or not. They cannot take that risk.

You must work in a paradise hospital if you have never seen that happen.

No hospital is a paradise, I have personally seen drug seeking behavior at the hospital I work at. But not on a level where anyone would ever consider banning pain medicine to everyone in the ER just to prevent it from happening.

Honestly, the thing I see the most in the ER is suicidal behavior. I did not realize it was that out of control.

**dogma**

KalashnikovMarine wrote:
It's also a giant festering sewer, so I suppose there's that.

Why thank you, Ra's al Ghul.

**KalashnikovMarine**

Cheesecat wrote:
KalashnikovMarine wrote:
Well if you're sane you don't own a car in New York City from what I understand. I certainly wouldn't from my visit.

Don't most people take taxis? Wouldn't the train be better?

Subway's the primary mode of transit, or walking

dogma wrote:
KalashnikovMarine wrote:
It's also a giant festering sewer, so I suppose there's that.

Why thank you, Ra's al Ghul.

Any time detective

**d-usa**

Dreadwinter wrote:
d-usa wrote:
Dreadwinter wrote:
KalashnikovMarine wrote:
Man why would any one live in NYC?

High taxes, psychotic rent, you can't even get a large soda from 7-11 and now once you inevitably get mugged the ER can't give you pain killers to help with the beating you just received along with the theft of your wallet and cellphone.

Hey man, they do not know if you beat yourself up just to get drugs or not. They cannot take that risk.

You must work in a paradise hospital if you have never seen that happen.

No hospital is a paradise, I have personally seen drug seeking behavior at the hospital I work at. But not on a level where anyone would ever consider banning pain medicine to everyone in the ER just to prevent it from happening.

Honestly, the thing I see the most in the ER is suicidal behavior. I did not realize it was that out of control.

We see it quite a lot in our hospital. One thing we are able to do is have our patients sign a contract with their PCP stating that they will have all their pain medications through them and/or the pain management team. If they seek pain medication any other way they loose all of it. The pharmacist in the metro area (I think it's a statewide initiative actually, but I'm not sure) also put together a central database that physicians and/or pharmacists can call. It keeps track of how many Rx were filled. So it lets you catch the people that have had 120 days worth of painpills in the last 30 days from 4 different doctors.

We do get the guys who beat each other up so that they can do to the ER, we get the good old fashioned fakers, we get the guys who threaten to tear up the place if they don't get what they want (they usually learn the difference between a hospital security guard and a federal police officer pretty quickly). Abuse of prescription pain pills is a rapidly rising cause of deaths and injuries.

**Piston Honda**

whembly wrote:
Piston Honda wrote:
Dreadwinter wrote:
whembly wrote:
d-usa wrote:
Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

Ditto... the ED is loaded with stories where patient coming in complaining about pain... when everyone knows they're looking for a quick fix.

Yeah! So we should punish everybody for those silly addicts!

I do not know about NY, maybe they have some sort of epidemic, but the hospital I work at does not have a lot of drug seeking behavior.

There are many people trying to get quick fixes from drugs in major cities. NY, Philly, Chicago, Boston, Detroit being someone of the places I personally know which happens a lot. oxycontin is huge in Boston and Detroit.

Yeah... what's sad is that these junkies are making it difficult for patients in real pain to legitimately acquire these pain meds....

Longer waits create possible shortages.

New York has a habit of screwing over innocent people when trying to fix a problem.

**Lone Cat**

The problems of many different formulae of painkillers (and several hospital-only medicines) are that it is not only addictive by itself (i.e. Morphine). some of it is a feedstock to illigeal narcotic industry.

Earlier in 2012. several state-run hospitals were put under investigations due to several cases of doctors and nurses corruption--smuggling of Pseudoephredine (usually referred to as 'Sudo'), and linkages to drug cartels in the neighbouring countries. the fact that Pseudoephredine can make Meth-Amphetamine (exists in various forms, the most common are the pure "Yaa Ice" and the low-grade "Yaa Baa" (Crazy Drug, Berserk pills)) is enough for the now-current government to put the Sudo under a very strict controls.
I've heard that Pseudoephredine is no longer supplied to hospitals in the U.S.

**gunslingerpro**

Along with drug seeking behavior, there has been an uptick in hospital employees stepping on (diluting) meds they give to patients in order to supply themselves with a fix. At least in the Northeast.

Remove the temptation, remove the risk and all that.

**liturgies of blood**

Seaward wrote:
While I think this particular example is a non-issue, I do believe you have to admire Bloomberg's firm commitment to ensuring no one ever utters the words, "They hate us for our freedom!" about his town again.

The freedom to die from addiction to easily available damaging drugs is a freedom to die for.

There have been some seriously messed up practices within prescription medicines in the american health system.
In many cases placebos are proscribed, for 30% of these cases in the US anti-depressents were prescribed, 20% were anti-biotics and the rest were a mix of vitamins and sugar pills.
This is why we can't have nice things and why we have MRSA.

**Ouze**

gunslingerpro wrote:
Along with drug seeking behavior, there has been an uptick in hospital employees stepping on (diluting) meds they give to patients in order to supply themselves with a fix. At least in the Northeast.

Remove the temptation, remove the risk and all that.

Indeed - there was a case relatively recently where a nurse infected a few dozen people with hepatitis, as she was secretly a junkie - she was taking the patients fentanyl and diluting theirs with saline or some such and re-using the needle. Just awful.

edit - I'm not endorsing Bloomberg's plan, though.

**tyrant of loserville**

azazel the cat wrote:
Dreadwinter wrote:
whembly wrote:
d-usa wrote:
Really, as much as I think the guy is an idiot, this is a good policy to stop the majority of ways that people who abuse drugs get their fix.

The people that are screwed by this are the folks without insurance who go to the ER because it is the only place that cannot tell them "feth off, you can't pay, we won't see you".

Ditto... the ED is loaded with stories where patient coming in complaining about pain... when everyone knows they're looking for a quick fix.

Yeah! So we should punish everybody for those silly addicts!

I do not know about NY, maybe they have some sort of epidemic, but the hospital I work at does not have a lot of drug seeking behavior.

I guess you work in one of these types of hospitals, then?

Spoiler:

cant stop laughing