Physicians agree that the abuse and diversion of pain medications is a serious public health threat and must be addressed. The Medical Society of the State of New York has worked closely with the Department of Health to improve accessibility to the database and to make the information contained in it more reliable. We believe that the DOH is on track to assure these changes are made. This issue, however, has become highly political. What is being discussed is a requirement for physicians and other prescribers to consult the database each and every time they write a prescription for a controlled substance.
What purpose does it serve to require:
* A busy pediatrician's practice to consult the database for all children who come in for their monthly prescription for ADHD medication?
* An oncology practice to consult the database for each cancer patient in need of pain relief?
* A psychiatrist to consult the database each time she is going to write a prescription for Valium or Xanax for a person with anxiety disorder?
* A primary care physician to check the database before prescribing Lyrica for a patient he has treated for 20 years who suffers from post-neuralgic pain related to diabetes?
It takes between four to eight minutes to click out of the electronic health record, log onto the database, download the information and then get back into the electronic record. For busy primary care practices where one physician will see approximately 30 patients, that's 2-4 hours a day per physician in the practice. A five-physician practice with two nurse practitioners would need to devote 14-27 hours of staff time each day to this task.
Last month, the Medical Society conducted a survey concerning the impact of the proposed legislation. Seventy percent of responders indicated that they would limit their prescribing of controlled substances to specific patients or would refer patients to pain management specialists. Due to concerns about abuse and diversion of prescription medications, patients with legitimate pain needs already are finding it challenging to get their needs addressed.
The primary focus of the media has been on what has been characterized as the over-prescribing of opiates such as hydrocodone or oxycontin. If that is where the problem lies, then that is where the focus of legislation should be.
We have proposed several steps to address the societal problem of prescription medication abuse and diversion. Our recommendations can also be found at www.mssny.org.
We must strike an appropriate balance between addressing the growing problem of abuse while also assuring that patients can continue to obtain needed medication.?
Robert J. Hughes, M.D., is president of the Medical Society of the State of New York.