Unmet Needs
Click to Enlarge
Colleagues:
Last week the MSSNY Pulse reported on my interview with the Gothamist regarding NYS efforts to decrease opioid prescriptions. A highlight was my comment that although the State had good intentions, an unintended consequence is that now there are unmet needs. Patients who legitimately need opioid prescriptions are not getting them or are facing extreme barriers to care. Since that article, I have received a lot of positive feedback from our members.
Among that feedback was a story from Dr. Nancy Nielsen from 8 years ago about an upstate pain management clinic whose physician director was indicted for being the #1 prescriber of opioids in the State. The director oversaw 10 mid-level providers who in turn cared for 10,000 patients. No insurer would pay for the mid-levels to provide care unless there was a physician with a DEA license onsite. The doctor was allowed to continue his practice but had to surrender his DEA license while administrative procedures were ongoing. There was a horrible public health crisis, which made a lot of media news. Sadly, many patients got admitted to local hospitals for withdrawal, some turned to the streets for the opioids (and died) when other physicians did not want to care for them and be the next one indicted, and there were at least 3 suicides we know of. There were urgent calls with the state health commissioner but there just were not pain physicians around to absorb these patients. This was the chilling effect on physicians that the war on opioids took – no one wanted to see these patients, who admittedly are not easy to care for.
As I am writing this, Dr. Brian White has sent me yet another thoughtful email on this matter. He writes, “I-STOP has played a role in decreasing ‘doctor shopping’ and getting large amounts of opioids either for use or resale. In this role it has been a useful program. However, why are we being mandated to search the I-STOP data bank for prescription for just a few days, or for two valiums to be taken prior to an MRI, or for medications such as Lyrica? I-stop needs to be restructured and the aspect of the program that is onerous for physicians needs to be identified and addressed.”
It is fortuitous that the NYS Department of Health is reconstituting the New York State Pain Management Steering Committee which will be meeting soon this summer. Expanding the 5-day exemption on I-Stop lookups to include more than just ER physicians would be a good suggestion for this committee to consider.
If you have any other suggestions on how to reduce the burden on doctors, do let MSSNY know, and we will forward your suggestions accordingly.
All the best,
Jerome C. Cohen, MD
MSSNY President
