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

[DogPawsBiscuitsNGrav]

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.
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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.

http://www.nytimes.com/2013/01/11/nyregion/new-york-city-to-restrict-powerful-prescription-drugs-in-public-hospitals-emergency-rooms.html?hp&_r=2&

Note to self. Never get hurt in NY

[Warpy]

1. Pity Boomberg won't benefit from this insanely cruel policy

Not only will he be able to avoid the ER when that root canal fails and he needs pain control until the antibiotics kick in and something can be done about it, he'll have an oral surgeon dancing attention in his office and a nice big bottle of Percodan delivered directly to him, no, sir, you won't have to stand in line at a pharmacy.

This policy is punitive and just plain nuts. Hospital workers know who the frequent flyers and drug seekers are. Prescriptions are already restricted to the people they need to be.

Refusing to allow doctors to treat legitimate pain is obscene.

[samsingh]

2. this is a very stupid and cruel thing to do

bloomberg is all over the place and hardly the hero i thought he could be.

i'm done supporting him in any way.

[JVS]

12. What ever made you think he would be any kind of hero?

As an outsider to NYC politics, the guy seemed a shitbag from day one. Sure he's not Giulliani, but that's not saying a hell of a lot.

[samsingh]

14. he was a Democrat at one time

[closeupready]

16. Christine Quinn agreed to overriding the two-term limit law

at Bloomberg's request. So Ms. Quinn deserves some of the opprobrium here, IMHO.

[catnhatnh]

3. As God is my witness

I pray he receives the most singularly painful disease or condition known to man.May he lay in bed week after week begging for a cheap drug he denied others because he judged them. May he hurt just like my back hurts every fucking day.Tomorrow may he wake as early as I do and God give him to live just like those he judges....

[Rex]

4. Kidney stones.

You don't have to go that far...he could just get a kidney stone (had them before) and then call someone up to bring him some painkillers. He is the Duke of New York afterall. So wishing him pain won't do any good. He can get anything he wants, he is the King.

[galileoreloaded]

5. What a dumbass idea. If you want to jack your liver....

on scrip abuse, who cares? Not the guy who needs them.

Dumb.

[Spider Jerusalem]

6. I don't see this as especially unreasonable

here in the UK you can walk into a pharmacy and buy codeine (combined with acetaminophen or ibuprofen, and not more than 12.8mg per tablet) OTC. The box has a big warning on the front: "For three days use only. Can Cause Addiction." You can't buy more than 32 at a time. Somewhere there has to be a balance between appropriate pain relief on the one hand and harm reduction on the other. (And for what it's worth the rate at which strong narcotic painkillers are routinely prescribed in the USA for all manner of things is strikingly abnormal compared to their use in the rest of the world.)

[cthulu2016]

8. You may be misunderstanding the issue.

Here in America we cannot buy any codeine OTC.

If you suffer a very bad sprain or a scalding burn or other very painful injury that doesn't require hospitalization and you go to the emergency room the doctor may well give you a small amount of some (effective) pills for the pain short term because you are in pain.

We are at the doctor's mercy for any strong pain relief.

And the idea that you could spill boiling water on your leg or something and go to the ER and can't walk out of the emergency room with a couple days of percocet or something, even if an ER doc thinks it reasonable, is rather nuts.

[Spider Jerusalem]

9. Except it's saying you can?

Three days' prescription only, from the article. Which isn't the same thing as "none at all".

[cthulu2016]

11. My bad. I misread it

How embarassing.

I read it as that the existing standard was three days, which was being eliminated.

I was wrong.

[JVS]

10. The reason for the large quantities are

1) These painkillers are often for treatment of chronic pain. For example, my dad was taking oxycontin to treat the pain of the cancer that was killing him. There are examples of more brief use. I was given a few days worth of vicodin after wisdom tooth surgery. But the amount dispensed here is traditionally determined by the physician who treats you.

2) Since it is expensive for patients to see the doctor, and the doctors are the ones who give you the permit to buy the medication, emergency room doctors are often willing to meet their patients halfway by prescribing enough to last until the next visit. So, if your doctor knows that you have chronic back pain and that it won't be getting better soon, a 90 day supply of the medication is not seen as unusual.

[Glassunion]

13. You can at least wash down the meager allowance of pills

With the teeny little soda they permit you to have.

Gotta love the dictator!

[closeupready]

15. Right, because everyday people in pain should pay for

drug abuse by addicts.

[JoeyT]

17. Can we get a few more threads about what a great guy Bloomberg is?

I really enjoyed those.

"Fuck your pain! Suffer you goddamned peasants!" = Progressive!

[Aristus]

18. It's actually a good policy, if one will take the time to think it through.

Emergency Rooms are not for managing chronic pain, or any chronic disease, for that matter. They exist to treat emergent conditions, like blood spurting from an artery.

Anything less than that, the job is to stabilize a patient, and send him or her along for appropriate follow-up; hospital admission, as necessary, or back to the patient's primary care provider.

A patient with chronic pain should follow up with primary care or pain management. If the ED prescribes more than a few days-worth of narcotics, it dissuades a patient from seeking appropriate follow-up; they just keep coming back for meds. The situation gets worse if the patient (like a lot of people in the US right now, unfortunately) doesn't have a primary care provider. No one is keeping track of how much medication the patient is getting, ordering appropriate monitoring labs for the patient, avoiding potential drug interactions, etc.

For example, I have a patient who is visiting with a mental health provider on a regular basis. Her current medication schedule does not include any benzodiazipine meds (alprozolam, lorazepam, etc). So her MH provider, a colleague of mine, is prescribing medications she judges to be appropriate treatment for the patient. However, I received an alert from the local Emergency Room that the patient presents regularly for prescriptions for clonazepam (which incidentally is the most widely abused prescription medication in the country right now, and responsible for the most deaths by overdose). If I didn't pass this info along to my mental health colleague, she might unknowingly prescribe a med that could cause a fatal interaction with the clonazepam the patient isn't supposed to be taking. Mandated restrictions on meds, and alerts to primary care providers are a good way to avoid deaths by overdose.

Okay. "How-dare-you-deny-me-my-medications-you-sadist?" in 3...2...1...