Reducing Opioid Prescription Painkiller Abuse, Mayor Bloomberg Announces New Guidelines

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Main Category: Pain / Anesthetics
Also Included In: Alcohol / Addiction / Illegal Drugs;  Public Health
Article Date: 14 Jan 2013 - 1:00 PST


New emergency room guidelines to prevent opioid prescription painkiller abuse have been announced by New York Mayor Bloomberg, Deputy Mayor for Health and Human Services Linda I. Gibbs and Chief Policy Advisor John Feinblatt.

The NY City's Mayor's office says it has created RxStat to fight opioid abuse and overdose. New York authorities released an initial report of the Mayor's Task Force on Prescription Painkiller Abuse. The report includes new (voluntary) guidelines for emergency rooms.

Mayor Bloomberg, who made the announcement at Elmhurst Hospital in Queens, says that guidelines will be used in all New York City's public hospitals. He explained that public hospital emergency departments will no longer prescribe long-acting opioid painkillers. Doctors in emergency departments will only prescribe a three-day supply of such medications - all destroyed, lost or stolen prescriptions will not be able to be refilled in emergency departments.

Opioid painkillers are some of the most powerful prescription painkillers on the market.

The number of painkiller-related emergency department visits in New York City rose threefold between 2004 and 2010 - from 55 visits per 100,000 people to 143 per 100,000. The guidelines have been introduced as part of an attempt to reduce the growing problem of prescription abuse and overdose "by encouraging judicious prescribing, patient education, referral to primary care and treatment for substance abuse when needed."

The guidelines are also designed to make sure there is not an oversupply of opioid painkillers. Approximately 75% of people who abuse painkillers get them from leftover medications. As well as introducing the prescribing guidelines, the Task Force report brought about the creation of NYC RxStat, which will utilize public health and public safety data to try to bring down the number of people who abuse painkillers.

The Task Force has initiated several public education campaigns and has worked with the State of New York to create an improved Prescription Drug Monitoring Program.

Mayor Bloomberg said:

"Prescription painkillers can provide life-changing relief for people in dire health situations, but they can be extremely dangerous if used or prescribed improperly. Working with health care providers and public health criminal justice experts our task force is providing the tools to fight a burgeoning epidemic while protecting legitimate health care needs. Together we are committed to addressing the violent impact that drug abuse is having on individuals and communities."

Deputy Mayor, Linda Gibbs said:

"Changing practice by front line providers is key to changing the course of this epidemic. While prosecutors and the law enforcement community rightly focus on those who illegally prescribe, dispense or procure painkillers, health leaders need to focus on encouraging well-meaning doctors and pharmacists to prescribe and dispense these medications safely and judiciously. Our work will proceed on all fronts to curtail the harms that come from painkiller misuse."

Chief Policy Advisor, John Feinblatt explained that prescription drug misuse is a serious public health threat. Opioid drug misuse does not only harm those who are addicted to such medications. Drug abuse is linked to criminal conduct, ranging from Medicaid fraud to pharmacy burglaries.

Prescription opioid painkillers pose similar dangers to society as illegal drugs do, Health Commissioner Dr. Thomas Farley said. It is important that prescription drug misuse is addressed effectively, while at the same time making sure that patients who come to emergency departments with pain relief needs receive appropriate treatment. Farley said the new guidelines are aimed at resolving these issues.

Dr. Farley said that opioid painkillers were not that different some street drugs, such as heroin. He referred to them as "heroin in pill form".

Dr. Farley added that over two million prescriptions for opioid painkillers are written each year in New York City - this is the equivalent of 25% of the city's population. Approximately 40,000 New York residents are already dependent on painkillers and require treatment.

Dr. Ross Wilson, Senior Vice President and Chief Medical Officer for the New York City Health and Hospitals Corporation, said "These new guidelines effectively balance our mission to relieve patients' pain against concerns about drug abuse, dependency and the illicit diversion of opioid medications. Under these guidelines, we can still treat acute pain of individual patients responsibly while limiting the risks that arise from significant quantities of unused narcotics sitting in someone's medicine cabinet."

Examples of opioid painkillers include:

• Oxycodone
• Hydrocodone (Vicodin)
• Morphine
• Methadone
• Fentanyl patches

Over the last ten years, the number of individuals in New York who have misused these medications and died from overdoses has increased dramatically. Between 2002-2003 and 2008-2009 the number of people taking non-prescription opioid drugs rose by 40%.

In 2008-2009, four percent of New York City's population (263,000 people over the age of 12 years) reported misusing opioid painkillers.

In 2010, 173 people died from accidental overdoses from opioid painkillers in New York City alone - 30% more than in 2005.

Emergency departments are being encouraged to display the new opioid prescription guidelines.

These new guidelines clarify that:

• Emergency departments will not prescribe methadone, fentanyl patches or extended-release oxydocone - i.e. long-acting opioid painkillers


• In the majority of cases, emergency departments will not prescribe more than a 3-day supply of opioid painkillers


• Lost, destroyed or stolen opioid painkiller prescriptions will not be refilled in emergency departments


• The posters also contain information on how to avoid unintended harms from such painkillers - these are available in several languages apart from English, including Russian, Chinese, and Spanish. New York City Health and Hospitals Corporation's 11 emergency departments have all agreed to adopt the guidelines. Private hospitals are being encouraged by New York's Health Department to adopt these guidelines too.

The Mayor's Office emphasized that not only has the significant increase in the number of people who misuse prescription painkillers led to a dramatic rise in opioid painkiller-related emergency room visits in the city, but also a steep rise in the number of deaths linked to these medications.

A study carried out by researchers from the Department of Veterans Affairs, Ann Arbor, Mich., and published in JAMA in April 2011 showed that patients on higher prescription opioid painkiller doses have a considerably greater risk of unintentional overdose and consequent death compared to those on lower doses.

Fatal overdoses from opioid painkillers have been a growing problem throughout the United States. Between 1999 and 2006 over 14,000 people died from prescription opioid overdoses annually - more than the combined deaths from cocaine and heroin overdoses.

This "epidemic" in substance abuse in New York City is different from previous ones in that opioid painkillers are produced and sold legally. If they are legal they are easier to get hold of. However, law enforcement officers and public health officials should find it easier to track their source and usage.

Special Narcotics Prosecutor, Bridget G. Brennan, said that their recent prosecutions have revealed the tragic link between opioid addiction and criminality. Drug dealers, including street sellers and unscrupulous doctors, make huge profits from painkillers. The key to reining in this epidemic is prevention. These new emergency department guidelines will help reduce the surplus of addictive pills, which are commonly sold illegally. Brennan said "Hopefully, these guidelines will serve as a model of responsible prescribing for the entire medical community."

Poor and uninsured patients may lose out

Critics say that emergency rooms are used by poor and uninsured patients as their primary source of medical care. The guidelines, when they are implemented, may deprive health care professionals who work in the public hospital system of the flexibility that they need to treat poor and uninsured patients.

Dr. Alex Rosenau, from the American College of Emergency Physicians said "Here is my problem with legislative medicine. It prevents me from being a professional and using my judgment."

New York city health officials said that patients in need of prescriptions for cancer pain or palliative care would still get their medications - the drugs would still be available outside the emergency room.

People with a painkiller problem are being encouraged to call 1-800-LIFENET.



Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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