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New York CITY Establishes New Emergency Department Guidelines Regarding Opioids

Date: January 15, 2013
Source: NY City Department of Health

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

New York City MAYOR Michael R. Bloomberg has stepped in to support new opioid prescribing guidelines governing New York City's 11 public hospital emergency rooms; the new regulations are desigend to restrict the availability of prescription controlled medications use to treat pain.

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.

Bloomberg and city officials claim the policy is 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.

Critics are not so sure. Some critics have pointed out 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.

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.

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.

Read the TaskForce Report here.

Read the emergency department guidelines here.

Link to additional resources for emergency department physicians here.

Poster for Emergency Department here

Handout for Patients here

 

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