Fed up with patients that don’t have legitimate reasons for taking prescription pain medications, emergency room physicians in southeastern Wisconsin will soon be giving large doses of tough love to patients who are doctor shopping.
Nationally, narcotic prescription medication abuse, including abuse of oxycodone and oxycontin, is on the rise. So within the next few months hospitals in Milwaukee County are going “Oxy-free” and a Racine-based emergency department is also looking into doing the same. The information-sharing group includes officials from Froedtert Hospital, Wheaton Franciscan, Columbia-St. Mary's, and Aurora Health Care.
Dr. Gary Swart, medical director for the emergency departments at Wheaton Franciscan’s Elmbrook Memorial, St. Joseph and The Wisconsin Heart Hospital campuses, said he’s part of a network of emergency department administrators that will be implementing tighter restrictions on how prescription pain medications are used and they want their patients to know about their policies prior to registering.
Swart said he and his staff are constantly confronted with drug-seeking patients – some who are legitimately seeking pain relief for chronic pain and some who are abusing prescription medications.
“In the Oxy-Free ED environment, we want to advertise to patients that we are not going to provide intravenous pain meds for chronic pain; that we won’t refill lost or stolen prescriptions for oxycodone and oxycoton, and we don’t provide methadone or suboxone therapy.
“We will do everything we can to relieve chronic pain with non-narcotic solutions to the problem. When a chronic pain patient shows up in an emergency room requesting narcotics or other pain medications, stating they lost their prescription, or ran out and their doctor appointment is days away, we will need to coordinate their care with their pain manager or physician who is monitoring their medication.”
James Soyka, MD, Chairman, Department of Emergency Medicine at Wheaton Franciscan Healthcare-All Saints in Racine, said they too are looking at implementing the program.
“At All Saints, we are familiar with (the Oxy-free) approach, and we are in the very early stages of discussing its application,” Soyka said.
An Oxy Free Emergency Department involves putting together lists of expectations of patients to deter them from doctor shopping. Doctor shopping is when people try to obtain multiple prescriptions from multiple providers. Among the techniques these emergency departments use are: checking the patient’s electronic health record to see if they have a contract with a pain management clinic; checking with pharmacies to see if the prescriptions they were given were filled recently or if they’ve made multiple visits to emergency rooms seeking pain medications.
Earlier this week, members of Physicians for Responsible Opioid Prescribing filed a petition with the FDA to limit the use of prescription pain medications. They want drug makers to stop marketing narcotic painkillers to people suffering from chronic, non-cancer pain. The petition also identifies doctors who are overprescribing the medications and writing prescriptions for high dosages as the reason for the label restrictions. But Swarts said regulating the use of the medications really doesn't address the whole problem.
"From my perspective, (the FDA labeling restriction is) an interesting approach to the opioid abuse problem because it focuses on one side of the problem: the regulatory side,” Swarts said. “However, this issue is much larger than tighter regulations, and is really never going to go away until we change the expectation of the patient in the patient/provider relationship.”
The Oxy Free approach focuses on setting a tone for the emergency room and allows doctors to target individual behavior. The policy also allows doctors to avoid confrontational discussions with patients because electronic patient records will indicate whether the person is under contract with a pain management clinic, if the patient has recently filled a prescription or visited other emergency departments outside their hospital system.
April Rovero, founder of the National Coalition Against Prescription Drug Abuse, applauds the Oxy-Free policies.
Her son, Joseph John Rovero III, 21, an Arizona State University student from San Ramon died from a prescription medication overdose on Dec. 18, 2009. Five months before graduation, Joseph had planned a road trip to visit doctor Dr. Hsiu-Ying 'Lisa' Tseng, a Los Angeles doctor who wrote 27,000 prescriptions over a three-year timeframe. She’s been charged with three counts of murder and one of those counts is Rover’s son.
“I would really like to see it taken a step further…if the doctor knows the patient has been doctor shopping or has history of abusing prescription medications, they can see it as an opportunity to counsel patients on where they can get help,” Rovero said. “Rather than just putting up a sign on a door saying 'go away,' we need our emergency rooms to take a stand and have people get recovery they need.”
In more cases than not, patients seeking pain medications are already seeing a primary care pysician, but when a patient seems to be abusing medications a number of steps can be taken, said Sadhna Morato-Lindvall, director of media relations and special projects with Wheaton Franciscan.
"Some emergency room doctors will refer a patient to see a social worker if they come to the emergency room more than six times in short time period," Morato-Lindvall said. "One of the physicians I spoke with said they have refused to prescribe medications."