New ER Guidelines to Prevent Opioid Prescription Painkiller Abuse
By NYC.gov - JAN. 10, 2013
Mayor Bloomberg, Deputy Mayor for Health and Human Services Linda I. Gibbs and Chief Policy Advisor John Feinblatt today released the initial report of the Mayor’s Task Force on Prescription Painkiller Abuse, which includes new voluntary emergency room guidelines for the prescription of opioid painkillers to prevent abuse.
The guidelines, which will be used in all of the City’s public hospitals, state that the emergency departments will not prescribe long-acting opioid painkillers; can only prescribe up to a three-day supply of opioids; and will not refill lost, stolen or destroyed prescriptions. Between 2004 and 2010, the rate of opioid painkiller-related emergency department visits nearly tripled in New York City, rising from 55 visits for every 100,000 people to 143 and the guidelines are designed to reduce 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 prevent an excess supply of opioid painkillers. We know that three out of four people abusing painkillers obtain them from leftover medications.
In addition to the prescribing guidelines, the Task Force report led to the creation of NYC RxStat, which will for the first time combine and use relevant public health and public safety data to combat the problem of prescription painkiller abuse. The Task Force has worked to raise awareness of painkiller abuse through public education campaigns and has worked with the State to create an improved Prescription Drug Monitoring Program. The Mayor made the announcement at Elmhurst Hospital in Queens, where he was joined by Staten Island District Attorney Daniel Donovan, Special Narcotics Prosecutor Bridget Brennan, Health and Hospitals Corporation Chief Medical Officer Ross Wilson, Senior Health Advisor Andrea Cohen, Dr. Lewis Nelson, Professor of Emergency Medicine at the New York University School of Medicine, and Dr. Stu Kessler, head of Elmhurst Hospital Emergency Department.
“Prescription painkillers can provide life-changing relief for people in dire health situations, but they can be extremely dangerous if used or prescribed improperly,” said Mayor Bloomberg. “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.”
“Changing practice by front line providers is key to changing the course of this epidemic,” said Deputy Mayor Gibbs. “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.”
“Misuse of prescription drugs is a grave threat to the health and safety of New Yorkers,” said Chief Policy Advisor Feinblatt. “Those suffering from addiction are not the only ones who are harmed by this epidemic. Drug abuse can lead to a wide range of criminal conduct, ranging from pharmacy robberies to Medicaid fraud.”
“Prescription opioid painkillers can be just as dangerous as illegal drugs,” said Health Commissioner Thomas Farley. “These new guidelines will help reduce prescription drug misuse while also making sure that patients coming to emergency departments have access to safe and appropriate pain relief options.”
“These new guidelines effectively balance our mission to relieve patients’ pain against concerns about drug abuse, dependency and the illicit diversion of opioid medications,” said Dr. Ross Wilson, Senior Vice President and Chief Medical Officer for the New York City Health and Hospitals Corporation. “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.”
“Given the important role that emergency departments have in the management of patients with pain, it is important that we maintain our ability to provide pain relief while keeping perspective on protecting the public health,” said Dr. Lewis Nelson, Professor of Emergency Medicine at the New York University School of Medicine. “The recognition that this problem can be addressed with a broad effort across emergency departments provided the initial step in addressing this important issue.”
“These guidelines will help emergency department physicians strike a balance between easing a patient’s pain and discomfort while helping to ensure that medications that can be abused are not over prescribed,” said Dr. Stuart Kessler, Board of Directors, New York State Chapter of the American College of Emergency Physicians.
Opioid painkillers include: oxycodone (e.g. OxyContin, Roxicodone), hydrocodone (e.g. Vicodin), morphine, fentanyl patches and methadone. In recent years, there has been an increase in the number of New Yorkers reporting misuse of these drugs and in overdose deaths involving opioid medication: Between 2002-2003 and 2008-2009 (the latest data available), self-reported, non-prescription opioid use increased by 40 percent, with 263,000 New Yorkers (four percent of the population) aged 12 and older reporting misuse in 2008-2009. In 2010, prescription painkillers were involved in 173 unintentional overdose deaths in New York City, a 30 percent increase from 2005.
The new opioid emergency department prescription guidelines, which hospitals can choose to display in emergency departments, clarify that:
- Emergency departments will not prescribe long-acting opioid painkillers such as extended-release oxycodone, fentanyl patches or methadone.
- In most cases, emergency departments will prescribe no more than a 3-day supply of opioid painkillers.
- Emergency departments will not refill lost, stolen or destroyed prescriptions.
- The posters also include tips to reduce unintended harms of opioid painkillers. The poster is available in English, Spanish, Chinese and Russian. The 11 emergency departments of the New York City Health and Hospitals Corporation, which operates all of the City’s public hospitals, have agreed to adopt these guidelines. The Health Department is encouraging private hospitals to adopt these guidelines as well.
Created by the New York City Health Department, the new voluntary prescription guidelines are endorsed by the Health and Hospitals Corporation and the New York State Chapter of the American College of Emergency Physicians, and were influenced by the City Health Information Bulletin on opioid prescribing, “Preventing Misuse of Prescription Opioid Drugs” and opioid prescribing guidelines practiced in other jurisdictions.
The large increase in people who misuse prescription painkillers has not only led to a significant increase in the number of opioid analgesic-associated emergency room visits, but also a higher number of painkiller-related fatalities. Unlike previous substance abuse epidemics, this epidemic involves substances – opioids – that are legally produced and sold. This makes the drugs easier to obtain, but also makes it easier for law enforcement and public health officials to track the source and usage of painkillers.
With this large amount of data available for analysis, the Task Force, in partnership with NY/NJ HIDTA, created NYC RxStat, which will track relevant public health and public safety data. Participants in RxStat, including representatives from an array of City, State, and Federal agencies (including the Drug Enforcement Administration), will meet regularly to share data and conclusions so that the appropriate City response can be targeted where it will be most effective in addressing the crisis. RxStat members will regularly report on critical indicators that measure the impact of prescription painkiller abuse on the City. In addition to this reporting, RxStat will convene briefings among public health and public safety stakeholders to share strategies and describe trends. This process will provide stakeholders with an up-to-date view of the problem so that they can coordinate efforts and use resources most efficiently and effectively.
“It has been my pleasure to serve with Chief Policy Advisor Feinblatt and Deputy Mayor Gibbs, distinguished healthcare professionals, and other law enforcement officials to help develop RXstat and the Emergency Department Guidelines for Opioid Prescriptions,” said Staten Island District Attorney Daniel Donovan. “RXstat marks a milestone in information sharing among those charged with protecting the public's health and safety. I am confident that the measures announced today will lead to enhanced enforcement of the criminal law, the adoption of best practices in emergency care and after-care, and more effective ways to combat the scourge of prescription drug abuse in our communities.”
“RxStat provides us with a truly unique opportunity to design the most effective strategies to reduce prescription drug abuse and its consequences,” said NY/NJ HIDTA Director Chauncey Parker. “By combining the knowledge resources of the key public health and public safety partners, RxStat creates a platform where we can use timely and accurate data to quickly identify emerging drug trends and then coordinate our response.”
“Our recent prosecutions have highlighted the tragic connection between opioid addiction and criminal activity. Painkillers generate huge profits for drug dealers, from street sellers to unscrupulous medical professionals. NYC RxStat is an excellent tool that will enhance our investigations,” said Special Narcotics Prosecutor Bridget G. Brennan. “Prevention is key to reining in this epidemic, and the new hospital guidelines will reduce the surplus of addictive pills, which are often sold illegally. Hopefully, these guidelines will serve as a model of responsible prescribing for the entire medical community.”
The combined data of various City, State and Federal agencies will ensure that city agencies responding to this crisis will be able to understand the total picture and will be able to adjust their response based on the ever changing circumstances on the ground. By analyzing the data and deploying resources more effectively, the City will be able to keep up with the ever changing patterns of drug abuse.
The full report is the result of a collaborative effort from the thirteen members of the Task Force, highlights the work done during the past year, makes recommendations for changes in policy and practice and describes the Task Force’s next steps. It is available at www.nyc.gov.
If you or someone you know has a problem with painkillers, call 1-800-LIFENET. For information on the emergency department opioid prescription guidelines, visit nyc.gov.
About the Mayor’s Task Force on Prescription Painkiller Abuse
A multi-agency Task Force created by Mayor Bloomberg in December 2011 and co-chaired by Deputy Mayor for Health and Human Services Linda Gibbs and Chief Policy Advisor John Feinblatt, the Task Force’s mission is to develop and implement coordinated strategies for responding to the growth of opioid painkiller misuse and diversion in New York City. Members include Staten Island District Attorney Daniel Donovan; Special Narcotics Prosecutor Bridget Brennan; Health Commissioner Thomas Farley; Executive Deputy Commissioner for Mental Hygiene Adam Karpati; Human Resources Administration Commissioner Robert Doar; Health and Hospitals Corporation President Alan Aviles; NY/NJ HIDTA Director Chauncey Parker; Police Department Deputy Inspector Raymond Martinez; and Department of Education Deputy Chancellor Kathleen Grimm.