Tuesday, March 5, 2013
San Diegans who want to get a refill of their narcotic painkillers from hospital emergency departments will soon have to look elsewhere.
More than 260 San Diegans died from drug overdoses in 2011. The vast majority of these deaths were linked to prescription painkillers like Oxycontin and Percocet.
Hospital emergency departments are reevaluating their role in dispensing these medications.
Bobby Stevens, not his real name, first started popping Oxycontin when he was in high school in North County. His classmates used to hand it out at parties.
Stevens soon became hooked. At the height of his addiction, he was taking up to 20 Oxycontin pills a day, plus the anti-anxiety drug Xanax and the amphetamine Adderall. He was spending $1500 a week on his habit.
Stevens used to get his a lot of his drugs from hospital emergency rooms. He had a few standard lies he would tell the doctors.
"That I either had lower back pain, or I did something to my knee, running," Stevens recalls. "It pretty much was the same story every time. I would go to different doctors, I wouldn’t go to the same ER. So I could pretty much use the same story."
Most of the time, ER doctors would give Stevens a prescription for at least a month’s worth of pills. He said he didn't have to do much acting.
"I would just explain the pain I had. But they were so busy, it seemed that they took you for your word, and wrote you the prescription," Stevens said. "I mean I didn’t have to do x-rays, I didn’t have to do an MRI, or any of that type of stuff. They just asked what I was there for, and they wrote me the scrip."
Sales of prescriptions opiates have skyrocketed in recent years. So have drug-related deaths.
The Centers for Disease Control says hospital emergency departments are the biggest source of these drugs.
"I think all the emergency departments are experiencing an incredible influx of opiate requests, and opiate-related emergencies," he explained.
Dr. Kelly said physicians can’t always tell when someone is really in pain, or just faking it.
"Our goal, first of all, is we want to help," Kelly explained. "So, each case we look at and we say, how can I help this person, and then second, we really want to do no harm. And that’s where a lot of narcotic issues come up; there’s a lot of harm related to the use and misuse of these medications."
The emergency department at Scripps Mercy Hospital in Hillcrest is one of San Diego’s busiest. More than 57,000 patients were treated there last year.
Scripps Dr. Roneet Lev said these days, about one out of five patients in her ED are taking narcotics.
"When you talk about cocaine or heroin, you talk about the drug lords in Columbia," Dr. Lev said. "And you talk about designer drugs such as spice and bath salts, those are the chemists in China. But prescription drug abuse and deaths usually are given by well-intentioned, well-meaning physicians, and we need to kind of change the way we practice, and get a hold of this epidemic."
To that end, Dr. Lev is leading an effort to change the way local emergency departments dispense painkillers. With the help of some other ED doctors in San Diego, Lev has come up with a set of guidelines.
Under the new rules, people who come to the ED for chronic pain will be directed to visit their primary care doctor.
"Someone who has pain for more than three months, or needs any long-acting pain medications that last in the body for a long time, those are the people who need to get all there prescriptions coordinated by one prescriber and one pharmacy," Dr. Lev explained.
These changes will not affect people with acute or sudden pain, from say a broken arm or a kidney stone. The new guidelines will only apply to those complaining of chronic pain.
"That’s the population at risk, who die unintentionally," Dr. Lev said. "They don’t know that they’re taking all these medicines from different providers, different prescribers. They got something from the ER, something from the psychiatrist, something from the primary care doctor. And people die from that. That’s what we want to get a grasp on and prevent."
She said there are some non-narcotic prescription drugs that are quite effective for chronic pain. Lamantia thinks doctors who prescribe narcotic painkillers need to be more careful.
“I think sometimes we feel it’s only a percent of people who might have a problem with the drugs, and that we as physicians are going to easily be able to pick them up. But that’s really not the case," she said.
All hospitals in San Diego and Imperial County have tentatively agreed to the new narcotic guidelines. They could be rolled out sometime this spring.
After eight years of abusing narcotics, Bobby Stevens has finally quit. He’s been in recovery now for four months.
Stevens wishes those emergency room guidelines had been in place back when he got hooked on painkillers.
"I don’t personally feel like I would be where I’m at today, if they weren’t so easily available," Stevens lamented.
In 2010, more than 16,000 Americans died from an overdose of prescription narcotics.