By Peter Sananman,
and Jeanmarie Perrone
'I need Percocet, Doc," the man said. He reported that he had fallen off a ladder the day before while cleaning gutters.
His request for that particular narcotic pain medication may not have raised suspicion if not for an astute clerk who recognized him. The clerk retrieved records showing the man had gone to the same emergency room four times over the past six months for alleged falls off a ladder. There's no telling how many other emergency rooms he had been to across the city.
This scenario is occurring across the country at epidemic proportions. While the opioids in prescription drugs such as Percocet and OxyContin serve as vital tools for the treatment of pain, they are being increasingly misused and abused.
Prescription opioid use rose 403 percent from 1997 to 2007, when there were more than 300,000 ER visits for opioid misuse. Last year, enough hydrocodone was prescribed to give every American adult 5 milligrams (essentially one Vicodin) every four hours for a month. With only 5 percent of the world's population, the United States now consumes 80 percent of the global opioid supply.
Of American deaths not caused by illness, drug overdoses are a leading cause, surpassing car crashes in 2009. And prescription drugs cause the majority of fatal drug overdoses, more than heroin and cocaine combined.
If the man described above had shown up at a hospital in Ohio rather than Pennsylvania, the emergency physician could have simply logged on to a state database and quickly learned the quantity and date of every narcotic prescription he had received. Today in Harrisburg, the state House Human Services Committee is expected to consider legislation that would give the commonwealth's physicians access to a similar prescription monitoring program. That database already exists for law enforcement purposes but isn't open to the state's physicians and pharmacists.
The legislation is part of a national trend that has seen prescription databases developed in 34 states. As Pennsylvania already has such a database, allowing physician access is a common-sense extension of the existing program. It will allow physicians to quickly learn important information that would otherwise require numerous calls to pharmacies, doctors, and hospitals.
More physicians are recognizing their culpability in the overprescription of narcotic pain medication, which can contribute to and even create addictions among the patients they are trying to heal. Conversely, feeling besieged by opioid abusers, physicians may erroneously refuse such prescriptions when they're appropriate. Studies have actually shown that access to prescription records doesn't lead to blanket refusals to prescribe opioids. In fact, it may increase appropriate prescriptions.
Efforts to determine when patients aren't telling the truth, as well as to gauge the proper frequency and amount of prescriptions, can be time-consuming and fruitless, especially in the fast-paced, 24-hour world of emergency departments. Patients, particularly those with multiple medical problems, are often treated by different physicians who may not be able to communicate with each other easily. This is a problem with respect to those seeking to abuse or sell opioids, as well as for well-intentioned patients who may find themselves accidentally overmedicated.
More rapid, reliable access to prescription information would increase safety and efficiency, ensuring that more patients with real emergencies are treated promptly and correctly.