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.
