Dispatches from the fight against homelessness and AIDS
Posted by Sunny Bjerk , May 15, 2013
Guest blog post by Emily Behar, Harm Reduction Coordinator at Housing Works
Early in 2013, Mayor Bloomberg and the Task Force on Prescription Painkiller Abuse announced new emergency room guidelines for all 11 public hospitals in New York City in an effort to curb the rapidly increasing rate of opioid analgesic addiction and overdose. The guidelines recommend that ER physicians no longer prescribe long-acting opioid painkillers; prescribe a maximum 3-day supply of opioids; and refuse to refill any prescriptions that are lost, stolen or destroyed. Opioids include: oxycodone, hydrocodone, morphine, fentanyl, and methadone. While Bloomberg is right to take action against the rising epidemic of prescription opioid abuse, I fear that these restrictions will force physicians to forgo their medical judgment in place of a legislative determination of best treatment.
The first foreseeable problem is that the City’s poor and homeless population often use emergency rooms in public hospitals for their primary care. They are often not linked to consistent medical care and utilize the ER for both emergency and chronic conditions. The new guidelines put these patients at risk of not receiving proper pain management. How can doctors manage patient’s health when they are restricted to blanket prescribing guidelines?
Additionally, I believe these guidelines do not target a significant contributor to prescription abuse. The New York City Department of Health and Mental Hygiene determined that 15% of prescribing physicians (“frequent prescribers”) write over 80% of all the opioid prescriptions in New York City. Research shows that some frequent prescribers write over 10,000 opioid prescriptions a year. It is essential that these physicians receive proper pain management training and are tightly scrutinized for ‘pill-pushing.’ If Bloomberg wants to curb opioid abuse in New York City, he needs to focus some of his efforts on these physicians.
Without a doubt, New York City has seen a dramatic rise in fatal overdoses in recent years. Between 2005 and 2011, NYC’s rate of fatal prescription overdoses rose by 65% and caused more deaths than heroin and cocaine combined. Additionally, between 2008-2010, there were more than 5.5 million opioid prescriptions filled by NYC residents. Yet there are additional measures that ought to be taken, outside of emergency rooms, to cut the rate of fatal overdose in New York City.
To start, the city should train medical providers, drug users, and law enforcement about Narcan-based overdose prevention and the Good Samaritan Law. (For those of you who don’t know, the Good Samaritan Law provides protection against arrest and prosecution for people who witness an overdose and call 911. The law also provides limited protections when the witness who calls 911 possesses a small amount of drugs). There is mounting evidence that both of these initiatives save lives. However, in order for their impact to grow, they need to be widely taught, acknowledged and respected.
I applaud the Mayor’s intent to give attention to the rising epidemic. However, his energy is misplaced by focusing on emergency room prescribing habits. If he wants to see effective and sustainable improvements, he needs to create effective pain management training for opioid prescribers while concurrently changing the cultural ethos around Narcan and the Good Samaritan Law.
-Emily Behar, Harm Reduction Coordinator at Housing Works
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