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zoom RSS 公立病院ERでの鎮痛薬処方を制限/米国医療事情・ニューヨーク

<<   作成日時 : 2013/01/14 23:02   >>

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 ニューヨーク市の11の公立病院ERで、よく使用される処方鎮痛薬のいくつかが使用制限となると、ブルームバーグ市長が発表した。
 バイコディンやパーコセットのような麻薬性鎮痛剤を3日以上の処方が受けられなくなる。オキシコンチンやフェンタニルパッチ、メタドンなどはすべて処方されなくなる。
 市当局によれば、薬物乱用の増加を抑制し、路上売買や10代の乱用を防止するのが目的だという。12才以上の25万人が処方鎮痛剤の乱用者であるという。
 癌性疼痛患者へは適応されず、ER以外で利用可能である。
 毎年、オピオイド鎮痛剤はニューヨーク市の人口の1/4に相当する200万処方以上が処方され、約4万人が治療が必要な鎮痛剤依存症である。2010年に173人が過剰摂取で死亡しており、5年前より30%増加した。

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New York City to Restrict Prescription Painkillers in Public Hospitals’ Emergency Rooms
http://www.nytimes.com/2013/01/11/nyregion/new-york-city-to-restrict-powerful-prescription-drugs-in-public-hospitals-emergency-rooms.html

By ANEMONA HARTOCOLLIS
Published: January 10, 2013

画像Some of the most common and most powerful prescription painkillers on the market will be restricted sharply in the emergency rooms at New York City’s 11 public hospitals, Mayor Michael R. Bloomberg said Thursday in an effort to crack down on what he called a citywide and national epidemic of prescription drug abuse.
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Under the new city policy, most public hospital patients will no longer be able to get more than three days’ worth of narcotic painkillers like Vicodin and Percocet. Long-acting painkillers, including OxyContin, a familiar remedy for chronic backache and arthritis, as well as Fentanyl patches and methadone, will not be dispensed at all. And lost, stolen or destroyed prescriptions will not be refilled.

City officials said the policy was aimed at reducing the growing dependency on painkillers and preventing excess amounts of drugs from being taken out of medicine chests and sold on the street or abused by teenagers and others who want to get high.

“Abuse of prescription painkillers in our city has increased alarmingly,” Mr. Bloomberg said in announcing the new policy at Elmhurst Hospital Center, a public hospital in Queens. Over 250,000 New Yorkers over age 12 are abusing prescription painkillers, he said, leading to rising hospital admissions for overdoses and deaths, Medicare fraud by doctors who write false prescriptions and violent crime like “holdups at neighborhood pharmacies.”

But some critics said that poor and uninsured patients sometimes used the emergency room as their primary source of medical care. The restrictions, they said, could deprive doctors in the public hospital system ? whose mission it is to treat poor people ? of the flexibility that they need to respond to patients.

“Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians and senior vice chairman of emergency medicine at Lehigh Valley Health Network in Eastern Pennsylvania. “It prevents me from being a professional and using my judgment.”

While someone could fake a toothache to get painkillers, he said, another patient might have legitimate pain and not be able to get an appointment at a dental clinic for days. Or, he said, a patient with a hand injury may need more than three days of pain relief until the swelling goes down and an operation could be scheduled.

Dr. Rosenau said that the college of emergency physicians had not developed an official position on the prescribing of painkillers in emergency rooms and that he appreciated Mr. Bloomberg’s activism in the face of a serious public health problem. But he said pain clinics in states like Florida and California, states where prescription drug abuse is rampant, as well as the household medicine cabinet, were probably a more common source of unneeded painkillers than emergency rooms.

City health officials said the guidelines would not apply to patients who need prescriptions for cancer pain or palliative care, and drugs would still be available outside the emergency room. They said that in this era of patient-satisfaction surveys, doctors were often afraid to make patients unhappy by refusing drugs when they are requested, and the rules would give those doctors some support when they suspected that a patient might be faking pain to get drugs.

“There will be no chance that the patients who need pain relief will not get pain relief,” said Dr. Ross Wilson, senior vice president and chief medical officer of the Health and Hospitals Corporation, which runs the city’s public hospitals.

Similar rules have been adopted in Washington State and Utah. Dr. Thomas A. Farley, the city’s health commissioner, said opioid painkillers were not much different from highly addictive and more taboo street drugs like heroin. He called them “heroin in pill form.”

More than two million prescriptions for opioid painkillers are written in New York City each year, the equivalent of a quarter of the city’s population, Dr. Farley said, and about 40,000 New Yorkers are already dependent on painkillers and need treatment. Painkillers were involved in 173 accidental overdose deaths in New York City in 2010, a 30 percent rise from five years earlier.

Officials could not say how many prescriptions were written at emergency rooms. Libby Holman, a spokeswoman for Purdue Pharma, which manufactures OxyContin, declined to comment.

Dr. Farley said the city lacked the regulatory authority to impose the new guidelines on its 50 or so private hospitals. But several private hospitals, including NYU Langone Medical Center in Manhattan and Maimonides Medical Center in Brooklyn, said they would adopt them voluntarily.

Dr. Hillary Cohen, medical director of emergency medicine at Maimonides, said that even now, OxyContin was rarely prescribed in the emergency room.

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