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St. Mary's changes pain medicine policy

Jul. 20, 2013 @ 12:00 AM

Hospital trying to help curb prescription drug abuse

HUNTINGTON -- A shift in policy at an area emergency room is being touted as another tool to combat prescription drug abuse in the Tri-State.

The new pain management policy, which took effect July 1 at St. Mary's Medical Center, is a combined effort to decrease unnecessary prescriptions and doctor shopping behaviors while still treating patients' individual needs, according to Paul Lageman, St. Mary's director of emergency and trauma services.

"The policy basically says, 'We're here to take care of you and it's important to us that we meet your specific, emergent needs, but we are not going to participate in or be a part of providing the unnecessary prescriptions that have created some of this area's -- and the nation's -- issues."

Lageman said the policy was originally implemented by St. Mary's with the opening of their medical center campus in Ironton in July 2012. The Ohio-wide policy for all emergency departments came under fresh guidelines titled "Emergency Room Protocols," announced by Ohio Gov. John Kasich, to limit prescriptions for opiates and other painkillers in an attempt to curb the diversion of prescription drugs handed out at emergency rooms.

Physicians may write a quantity of pills to tide over those in severe pain until they can be evaluated by their primary care physician. Emergency room doctors are also encouraged to check the statewide prescription database for doctor-shopping patients, those who intend to deceive in order to obtain controlled substances from multiple physicians in a short time frame, and to be on the lookout for fake IDs.

In West Virginia, which leads the nation in overdose deaths from prescription drugs, no such formal policy exists. An article appearing in the Journal of the American Medical Association about unintentional drug overdose fatalities in West Virginia reported that opioid analgesics were involved in 93 percent of deaths, and 21 percent of fatalities involved patients described as "doctor shoppers." A study by the National Center on Addiction and Substance Abuse showed that physicians perceive doctor shopping to be one of the main mechanisms of prescription drug diversion.

Lageman said the policy was well-received at the Ironton campus with few complaints, and hospitals administrators made the decision to implement the policy at the Huntington campus this month. St. Mary's Huntington emergency room sees about 1,200 to 1,500 people every week. Lageman said the policy sets a standard of helping those patients by fixing the underlying problems, not throwing pills at the symptoms.

"If it's a medical problem, we'll fix it. If it's pain, we'll assess the patient's needs and provide enough medication, a three-day dose, to get them to their primary care physician. If they don't have one, we'll help them find one. If they have chronic pain, we'll help them develop a plan and refer them to a pain clinic," Lageman said. "And if they need substance abuse or behavioral health help, we'll help get them in that referral stream.

"We want to find the underlying problem."

Lynn Ormiston, program coordinator with the Cabell County Substance Abuse Prevention Program, said CCSAPP was looking forward to learning more about St. Mary's renewed efforts to reduce the potential for misuse or abuse of prescription drugs.

"It certainly does take the combined efforts of members of our community to address this big issue and to ensure that those who need help have access to it," Ormiston said. "Prevention belongs to everybody."

Emergency room physicians will be more actively checking the prescription drug monitoring program provided by the West Virginia Board of Pharmacy and may require photo identification and urine drug screenings before authorizing prescriptions.

"We're not going to refill lost prescriptions or provide quantities of controlled substances. We will address your emergent need in a patient-focused and individualized way," Lageman said. "Part of this is creating a dialogue with patients, particularly if we see what appears to be a recurring refill on a particular prescription two or three times in a week, and telling them here's what we can do and will do, but also what we won't do."

Follow H-D reporter Beth Hendricks on Facebook or Twitter @BethHendricksHD.

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