Emergency Room Is New Front In War On Prescription Drug Abuse

May 8, 2015

Tracy Garcia, ER Director at Cheyenne Regional Medical.
Credit Miles Bryan

Kimberley Enyart was never interested in doing recreational drugs. But then she was in a car accident and her doctor prescribed a powerful opiate for the pain.

“It just, I don’t know it put me off in la-la land it made me feel better,” she said. “I don’t know, I loved it. I loved that high.”

When Enyart’s prescription ran out she did whatever she could to more from other doctors in town. Eventually, she moved on to dentists.

“I even had two back teeth pulled for it.”

Eventually, she ran out of doctors to fool. In the last decade, every state except Missouri has a built a prescription drug monitoring system, which lets doctors look up the prescription history of patients they find suspicious. So Enyart went to the last place in town she could still legally get some pills: the emergency room.  

"I would do anything from saying I had a migraine to having side aches,” she said. “And most of the time, yeah, I walked out of the emergency room with a prescription.”

In the last few years, the ER has become the destination of choice for those seeking addictive prescription painkillers like Vicodin, Oxycodone, or Percocet. In Wyoming, prescription drug overdoses have more than tripled in the last 15 years. In response, hospitals in Laramie, Casper, and Cheyenne have developed tracking program specifically tailored to the Emergency Room. 

At Cheyenne Regional Medical Center ER Director Tracy Garcia points out the bold red letters that appear on patients’ electronic records when they’re flagged as abusers. She said with Wyoming’s existing prescription monitoring system it hasn’t been easy to track abusive patients. Her doctors work twelve-hour shifts that come with an overflowing waiting room -- which meant that, even if they found a patient suspicious, they couldn’t always look into it.

“When I have fifteen people waiting for treatment I want to get in, find out what’s going on with you, and get your care started right away. So that you feel better and I can move on to the next patient.”

I would do anything from saying I had a migraine to having side aches. And most of the time, yeah, I walked out of the emergency room with a prescription.

Now the difficult decision of whether to withhold drugs won’t be made by the doctor on duty, Garcia said a  hospital panel made up of doctors, administrators, and others will meet once a month decide whether patients flagged for unhealthy behavior should officially be labeled abusers. They are watching for signs like more than a few visits to the ER in a given month.

“One day they may be here with a headache, one day with a backache, one day with dental pain,” Garcia explained. “But these are all things they request medication for.”

When the patients are flagged the hospital sends out certified letters telling them they won’t get prescription painkillers for anything other than a dire emergency.

This kind of program has already had a big impact at hospitals around the country. Dr. Eric Ketcham helped created one at San Juan Regional Medical Center in New Mexico a few years ago. “We assumed we would probably lose money,” he said. “We thought of it as a public health initiative.”

But after crunching the numbers Ketcham said he realized the hospital had cut down its emergency room visits by five percent a year and saved about half a million dollars: “That’s six full-time ER nurses.”

Still some doctors are nervous that these kinds of programs could tie their hands.

Alex Rosenau is with the American College of Emergency Physicians. He pointed out that the emergency room is there to treat people when their primary care doctor is unavailable, while for poor people it can be the only medical care they have access to. He says these kinds of guidelines may discourage doctors from giving out pain medication when it's really needed.

“If somebody is an abuser of Vicodin or another medication... if they break a leg or break an arm they are still going to need medicine.”

But Rosenau agreed that the question of who should get drugs and who shouldn’t needs to be coming up in every part of the medical community. In 2013 prescription drug overdoses killed an average of forty-four people every day in the United States.