Carney: Seek balance in a new pain-pill law

Last week, a Suffolk grand jury released a report showing a dramatic increase in arrests and overdose deaths related to prescription painkillers in the county. Advocates for new legislation used the opportunity to once again urge passage of a bill to track prescriptions of controlled substances. But the state must not lose sight of the patients who need these medications most -- those who suffer indescribable pain because of advanced disease.

As a society, we, of course, need to be sure that the benefits of these opiate medications exceed their risks and potential harm. But the good these medications do has been lost in recent discussions.

As a physician trained in internal medicine and geriatrics, I participate in medical rounds with geriatric medicine and palliative care teams. These professionals care for individuals from all walks of life who are severely ill with complex conditions and are at their moments of greatest suffering. The health care providers meet as a team to discuss how to manage their patients' diseases and relieve the patients' and families' anguish.

These patients all expect to go home with chronic pain that will likely escalate as their diseases progress, and they need help as that happens.

Consider these examples: A 60-year-old man with pancreatic cancer suffers with chronic, devastating abdominal pain and nausea that affects his ability to function on a daily basis. Without opiate medication, he cannot eat, dress himself, walk or even sit up to have a discussion. A 68-year-old man has a slowly growing chest mass that is eroding through his skin. Without a long-acting medicine such as oxycodone, he describes the feeling of a burning branding iron that shoots caustic pain across his chest and through his core with every breath. An 81-year-old woman has a wound on her lower leg from poor circulation that has not improved despite multiple invasive vascular surgeries. The only relief she has despite aggressive medical care is with the appropriate and careful use of opiate medication.

These are just examples that I can write about; there are many others who live with horrible pain that cannot be adequately described.

On Long Island, more so than in other parts of the country, there are two important demographic shifts under way that affect the increase in legitimate opioid use: The population is growing and the population is aging rapidly. With increasing age comes an increase in diseases such as cancers, arthritis, hip fractures, joint replacements, chronic pain syndromes and hospitalizations.

We live in an extremely advanced medical environment with 12 hospitals and 8,000 physicians in Nassau County alone. We are living longer, with more advanced and chronic disease. Pain management and palliative care efforts have expanded, and with them, the use of opioids has increased. Few analgesics are available that are as safe and effective as opioids, when used properly.

So we must consider these individuals and how the proposed legislation may affect their ability to live comfortably at home. The Internet System for Tracking Over-Prescribing (I-STOP) legislation subjects physicians to penalties if the system is not utilized completely. This, in turn, will limit access to these medications outside of the hospital and within the community where patients live, because physicians may be reluctant to risk the penalty. This limited access will not result in better medicine, improved quality of life or improved outcomes, and it may have the unintended consequences of more and longer hospitalizations.

Opiates are already the most highly controlled medications that exist. Despite the laws that have passed and the attention that has been given to pain management over the past few decades, the Medical Society of the State of New York in 2005 and the U.S. Institute of Medicine in 2011 report an undertreatment of pain by physicians, and difficulty accessing proper pain medicines outside of a hospital for various reasons. Further barriers will only hurt those who need these medications most. The proposed legislation targets all physicians, and indirectly harms patients, when instead it should focus on the doctors and patients who abuse and misuse these prescriptions.

The balance of how to protect the public against abuse while protecting patients' access to needed medication is the challenge facing our legislators. Let's maintain compassion both to the public whose access to these drugs should be limited, and to the patients in pain, whose access should be judiciously managed.