Asymmetrical Information - Megan McArdle

01.11.13

Bloomberg’s Latest Crackdown: Prescription Drugs

ERs will face stiff limits on prescribing pain medication.

Prescription drug abuse is growing, and it's getting expensive. New York's Mayor Bloomberg has announced a new initiative to crack down: 

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.

The administration says that "There will be no chance that the patients who need pain relief will not get pain relief." I'm not so sure. A lot of people use the ER as their primary-care physician. And no, I know what you're thinking—it's not just because they can't get health insurance, so Obamacare is not going to fix it. Massachusetts saw an increase in the number of ER visits when they put a similar program in place.  

That's because people don't use the ER simply because they can't pay; they use it because their symptoms emerge outside of office hours, or because they find it difficult to take off work from 8–5 on a weekday, or because they can't find a primary-care physician. Limiting the number of pain prescriptions that are written at the ER is going to mean more pain for folks who are legitimately unable to get a doctor's appointment in time.  

Of course, I assume that this will also make it harder for addicts to get the prescription drugs with which they are currently screwing up their lives. But it's hard for me to view this as a worthwhile tradeoff. It seems fairly horrible to keep people in bad pain, incurred through no fault of their own, in order to protect other people from themselves. I'm not minimizing the problem of prescription drug abuse, mind you; I've known a few people who've had a hard time with it. But I've also known a few people who were in chronic pain, and I know which one I'd choose.