Area ER Doctors To Limit Who Gets Prescription Pain Meds

As prescription pain medication abuse continues to rise, area emergency rooms will likely go Oxy Free in the next few months, meaning patients might get a little more tough love.

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."  

Absolutelyfabulous July 27, 2012 at 11:08 PM
Across the border traffic/day trips should see a nice spike in traffic. That should add a new dimension to what are currently some of the most violent places on earth due to the fighting between drug cartels and gov't forces. Viva Mexico!
superdavefive July 27, 2012 at 11:44 PM
I agree that we need to take these steps to make it more difficult to get these prescription drugs. My fear is that many users may end up switching to heroin to keep up with the need for opiates or make other poor choices such as holding up a pharmacy.
Str8shooter July 28, 2012 at 12:13 AM
This is a good start but a lot more has to be done. Very little amount of oxycodone is being illegally obtained from ERs although some is. ER typically only prescribe a very small supply so most addicts don't waste their time. Most addicts doctor shop by having a handful of different regular doctors and then fill the scripts at different pharmacies so no one knows they are getting a supply enough for 6 people. I believe Wisconsin is the last or at least one of the last states not to have a Presciption Monitoring Program which connects all the different pharmacy records. Wisconsin should have this program up and running within the next year. Addicts will unlikely drive to Mexico for an immediate fix. They will likely use heroin since its cheaper and gives a better high in most cases.
Str8shooter July 28, 2012 at 12:21 AM
Doctors are very naive that almost all patients obtaining oxy are addicts and selling their pills. A pharmacist from a local pharmacy said when Purdue pharmacies changed the makeup of OxyContin to a formula that is more difficult to abuse, all but 5 patients had their doctors change their scripts to a lesser strength oxy script that can still be abused. If the doctor felt these patients needed the stronger OxyContin why would they ever change it to the less strength oxy product. Doctors are constantly being investigated for over prescribing and "selling" prescriptions to addicts. Pharmacists also should see the signs. It's a huge problem in the medical field because they never see the end result of crimes being committed, addicts' lives being ruined, and addicts ODing.
Absolutelyfabulous July 28, 2012 at 12:35 AM
As poppy fields flourish in Mexico, heroin use surges in U.S. "A coincidental factor has given the drug gangs a tail wind: The epidemic abuse of painkillers has ebbed in the United States, and youth now hunger for a cheaper high. "We've heard around the country of changes away from prescription drugs, because they are either more expensive or more difficult to obtain, and a movement toward heroin, which is less costly," said Gil Kerlikowske, a former Seattle police chief who's the White House drug czar. The U.S. State Department said in March that Mexico has surpassed Myanmar as the world's second largest poppy cultivator and produces 7 percent of the world's heroin, mostly for the U.S. market. The State Department and the United Nations say that Mexican poppy production has nearly tripled since 2007, though Mexico strongly disputes that estimate." http://www.mcclatchydc.com/2011/06/29/116739/as-poppy-fields-flourish-in-mexico.html
Matt Palmer July 28, 2012 at 12:48 AM
And so those of us who have actual legitimate reasons for needing narcotic medications have to suffer because of the junkies. These doctors need to be re-educated and get a clue about what addiction really is. Not make the rest of us suffer needlessly. AURORA!!! Please build a hospital here!
Absolutelyfabulous July 28, 2012 at 01:14 AM
At about $15 a hit, heroin is a lot cheaper than prescription painkillers such as oxycodone (known by its brand name, OxyContin), which can cost $50 to $80 a tablet on the black market. Both opiates, they have similar highs. http://www.mcclatchydc.com/2011/06/29/116739/as-poppy-fields-flourish-in-mexico.html
Craig July 28, 2012 at 01:41 AM
You are 100% right. It sucks I can't buy a damn decongestant without showing ID and signing for it. Yet I was able to obtain morphine without being asked for my ID. Because of the addicts, the people that really matter suffer.
Str8shooter July 28, 2012 at 01:59 AM
I'm not a doctor so I can't confirm this but there are many doctors that are now saying the stronger opiate narcotics such as oxycodone and morphine should almost never be prescribed because there are less addicting pain killers that are even more effective. The addiction people are experiencing even to legitimate patients is more detrimental than the pain The only difference between heroin and some opiate prescriptions is heroin is not regulated. They have the same addiction risks and physical effects on the body and obviously no one would ever want heroin prescribed to them. I completely agree about the stricter regulations on sudafed compared to narcotics.
Greg July 28, 2012 at 02:05 AM
"Barack Obama won the Presidency in 2008 by stating that "Health care was a right, not a privilege". If it is now a right, are they not disenfranchising you by making you show an ID? Minorities, the poor and the elderly don't have IDs, how do they practice their right to health care?
Greg July 28, 2012 at 02:10 AM
I understand that the average M.D. gets an exceptionally small amount of education on addiction, as part of their medical education.
Str8shooter July 28, 2012 at 02:12 AM
Those prices were accurate when OxyContin was able to be abused. An 80mg OC was $40-$80 per tablet but since they were reformulated a few years ago the most popular abused pill is a 30mg oxycodone commonly mistitled by addicts as percs (percocet). This 30mg oxycodone tablet goes on the street for $20-$30 while enough heroin for about one use is $10. The majority of people abusing and selling these pills are addicts themselves however with the demand from addicts many others have joined the business of selling these pills due to a typical script of 120 tablets going for $3,000. So now someone is doctor shopping and has only 3 doctors. That is $9,000 a month! It is an incredible epidemic which no one has an answer to.
Racine WI July 28, 2012 at 05:38 AM
No way Jose, 30mg oxycodone (roxys) have a street value of $15. Oxycodone is sold for 50¢ a mg. Anything more and you're being ripped off. Granted that's still $1800, but only if they sell their entire script. Most keep some meds for themselves. My friend, for example, is on a fixed monthly income due to being in disability. Her monthly check barely covers her rent and utilities. She does receive "food stamps" but if she didn't sell some of her meds, she would have no $ for her phone, gas, car insurance, or school supplies/clothes for her daughter. I don't necessarily agree with what she does, but what other option does she have when she would give anything to work, but is physically unable?
jbw July 28, 2012 at 09:23 AM
Maybe she could move up the food chain and become the one writing the prescriptions? It's not like the doctors doing it now exhibit any genuine skill or intelligence, so an untrained disabled person should be able to take their place with no problem!
Str8shooter July 28, 2012 at 11:15 AM
I completely agree it is a ripoff but with what I do for a living I haven't seen a 30mg sold for $15 in a couple years. It's normally been $20-$25 but I've seen as high as $30 just because the people that have the scripts or are stealing them know the addicts will still buy them. Either way my point is there is a huge business behind them on the street more than anyone in the medical field realizes.
Genuine CCP July 29, 2012 at 05:16 PM
Genuine CCP Because of all the current regulations, enforced or not, it is all but impossible for find a doctor willing to prescribe ANY kind of opiate painkiller. Instead they want me taking anti-depressants, anti-convulsants, or even anti-psychotics. None of which do anything for my pain. I am made to feel like a junkie if I even DARE to ask for some kind of opiate pain medication. My dentist is more willing to prescribe 24 5/500 Hydrocodone after having teeth removed than my primary care doctor. HIS latest gambit is to put me on an anti-anxiety medication, telling me that stress is causing my pain! The stress IS NOT causing my pain. The pain is causing me to stressed! Isn't it time for the FDA and all the other people wanting to regulate pain medications out of existence to show a little compassion to those of us who have never abused our medications, yet will never be prescribed an opiate because of other people's abuse and addiction problems.
Str8shooter July 29, 2012 at 08:38 PM
You just need to find the one of about a dozen irresponsible doctors in the area and they'll just start handing them out. Trust me I understand the complaint about the chronic pain but coming from working with opiate addicts I know your doctor has your best interest in mind although it doesn't seem like it. I have never seen anyone not become dependent on opiates to some degree that have it as a prescription. It's equivalent to using heroin on a daily basis and no addiction is harder to beat than opiates. That's why so many athletes and actors go into rehab after a simple prescription from even a temporary injury or surgery. I for one don't care how bad my chronic pain is or what type of surgery I've undergone, I turn down the doctors when they offer the opiate scripts.
Keith Schmitz July 29, 2012 at 10:17 PM
Why don't you go into the central city and find out?
dave July 30, 2012 at 06:13 PM
Most doctors -especially er doctors havent bothered to obtain any education in pain care- and so to say theyll use nonnarcotic treatments for pain is ridiculous. Doctors remain prejudice against people in pain and refuse to do what is right by learning how best to treat pain. Their medical education is poor as it excludes pain care- and pain is the major reason why people seek medical care. Doctors are a danger to the publics wellbeing due to their careless neglect. And if people knew how ignorant doctors are when it comes to pain care they would demand a revolution in medicine.
Greg July 30, 2012 at 06:44 PM
Ahhh, the "Pelosi Reply". I expected no less.
jane collins July 31, 2012 at 07:12 AM
I am a sickle cell patient and I believe this is not fair you damn junkies make people with real health problems go through we already go through a lot i dont like taking narcotic pain medication but if it helps it helps but you want to take it for high or get them for a income you ought to be ashame of yourself you are literally robbing from the sick for pleasure and it hurts
Kristi Christianson August 06, 2012 at 10:52 PM
It is not the chronic pain sufferers that need to be punished if some dumb ass people who dont need the medications,OD and die! Why should we be punished? Most of us cannot get through the day without some type of pain medication! And you want to take away the patients rights to be properly treated and have some type of quality of life, taken away because people are abusing it and overdosing?I believe your looking at trying to solve this problem the wrong way! Why not take a look at the people that are seeking medications and have nothing wrong with them? A lot are receiving it and selling it!
Anthony September 10, 2012 at 08:29 PM
I agree its a big problem. Dr's have medical records to look at for a reason. I have metal screws n rods holding my spine together. I can't make it through the pain without my pain meds. 8 years ago i was hit head on by a drunk driver. Chronic pain n injuries to my S-1 to L-5 discs. 3 major surgeries. why should i suffer more because of morons who have nothing wrong. But I to sometimes get treated like Im the drugy . its not right.
Bren September 10, 2012 at 08:39 PM
We've become a medicine-dependent society. Ads depicting better lives through science ("Ask YOUR doctor about [insert drug name here]) all over tv. As my chiropractor said, so many people reach for the medicine cabinet when they have aches and pains instead of trying stretches, etc. Consider how many pharmacies may be found in Milwaukee County (yes, they do sell other items). In addition to the stand-alones like Walgreens and CVS, Pick n Save, Target, Walmart have pharmacy sections. Aurora has multiple pharmacies. Every grocery store has a stock of over-the-counter meds. They have every right to sell medications but it does have a downside of creating top-of-mind presence. Multi-symptom over-the-counter pain medications add chemicals to the body that are not needed. Also, how many headaches are caused by lack of sleep? Here's an interesting article about how lack of sleep impacts the workplace: http://healthland.time.com/2011/09/01/the-high-cost-of-bad-sleep-63-billion-per-year/ I think it's a good move to start limiting pain medications to those who truly need it, and to increase education about the dangers of medication abuse. I would also suggest some type of rating system for pharmacies to reduce break-ins. It could be something as simple as signage about types of drugs not sold at that location. I agree that this is unfortunate for individuals who need the medication.
jim allen December 03, 2012 at 12:14 PM
jim allen December 03, 2012 at 12:40 PM
I find it very interesting that you would say no to opiates if offered, it is obvious you have never felt pain for more than a few hours, maybe a little pain over several days, do you know what chronic pain is like, to suffer for years, YEARS, not hours or days with a little ache, have you ever had surgery ? I have had it, 17 times, and I still have four more to go though, I have never abused my meds, never sold them, never lost them, I am a law abiding person who happened to be born with a degenerative bone disease and have been suffering since I was diagnosed at 13 years old, but I am easily forgotten about from people like you who have no idea what it is truly like to suffer with pain on a daily basis, and it doesn`t get any easier, I dont have the answer to the problem, but I can assure you you, in a very short time in my body and you would see things much differently. "Trust me, I understand about the chronic pain complaint" If you could, please explain about chronic pain and how you know about it.
Keith Schmitz December 03, 2012 at 12:58 PM
Just imagine if some doc did that to Rush Limbaugh. Who knows? He might have built some character.


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