New rules proposed to curb skyrocketing use of painkillers

Just 15% of health care providers prescribe 82% of the pain killers in New York City, according to a new data analysis performed by a mayoral task force, which proposes strengthening the state's prescription drug monitoring program and increasing the training required of some health care providers.

NYS Health Department data revealed that opioid prescriptions surged 22% between 2008 and 2010. City records show that overdose deaths attributable to such painkillers have increased 30% since 2005.

"Primary care physicians, pain management and other specialists, including dentists, can reduce the risks of misuse and overuse of opioid medications by prescribing them much more cautiously," said NYC Health Commissioner Thomas Farley.

More than two million opioid prescriptions were filled by New York City residents in 2010, with the highest rate of prescriptions per person going to Staten Islanders and the lowest to Brooklynites, according to the Mayor's Task Force on Prescription Painkiller Abuse.

Dr. Barton Inkeles, an internist on the Upper East Side, said that while the proposed rules would add yet another layer of bureaucracy to practicing medicine and may make it harder for legitimate patients to get the drugs they need, new rules could help curb the over use of drugs such as Percocet, Vicodin and Oxycontin. Every day, he said, he confronts patients "trying to weasel drugs off you. If you had an ally, and had to say to the patient, 'I have to put your name through this website,' it might help," reduce unnecessary prescriptions.

In "easy cases," he tells patients "you don't need this," and they drop the request, but some are insistent. Inkeles said he uses the state registry now, but selectively, checking only on patients he suspects of doctor shopping, drug-stockpiling and lying.

It's no surprise that just 8,000 or so of 54,582 health care providers write 82% of the scripts for opioids in New York City, said Inkeles, who termed that revelation a "distortion," that mistakenly suggests there is a large contingent of overly obliging physicians. "I'd like to see the data when the oncologists and the pain management specialists taken out. If you're an oncologist at Memorial Sloan Kettering, you could be writing 20 to 30 opioid scripts a day," said Inkeles.

What is most needed, said the physician, is patient education. "Most people don't need pain meds," said Inkeles, but "culturally, our society doesn't tolerate discomfort. We want to feel better right away.