Narcotics, Pain, and Medicaid in New Jersey

A new law has hit the people of New Jersey, the home of the toughest narcotics laws in the nation, in an effort to stem deaths from heroin and opioid addiction. The target? Law abiding physicians—as if physicians were the cause of this scourge.

Now patients with extensive dental work and major surgery are not allowed to receive more than five days of Percocet in one script. If they are still in pain after five days, they must obtain a written prescription for five or 25 more days. If patients have cancer or chronic pain, they can continue to obtain a script for 30 days at a time.

The problem is very serious, with 1,600 N.J. deaths from overdoses of opioids and heroin in 2015, yet who is trying to determine the cause? Heroin is already illegal. This law will have no impact on the illegal heroin trade.

The assumption is that patients take these medications beyond the time that they need them. By 30 days, the pain is believed to be gone, but the addiction has been established. But in fact, many people with remediable causes for pain do not have access to pain-ending surgery or pain-control physicians.

In our free clinic, the Zarephath Health Center, in central N.J., we see patients who have very poor access to care. Half of these patients are on Medicaid, the government program that was extended in our state under ObamaCare. In our 14 years of existence, we have discovered three areas that are very poorly served by Medicaid: psychiatry, pain control, and elective surgery.

One of our patients, a woman in her 20s, fell and fractured her femur, the long bone in her leg. For various reasons, she did not have immediate surgery and was sent home. Then it became impossible to find a doctor for her. She could not walk, was wheelchair bound, and was in constant physical and emotional pain. When the pain became unbearable, she would call 911 and be transported to the emergency room, where she was callously told that her leg was still broken—nothing new, not an emergency. Muscle spasms would cause her to scream in pain. We prescribed opioids and began to explore the story behind the story. The problem seemed to be poor Medicaid payment combined with full liability exposure for the doctor. We finally found a doctor and offered to pay a fair fee with our charitable donations. Once the patient’s hip was replaced, she stood up for the first time in three years.

Another Medicaid patient suffered extensive burns on her face, neck, and torso from a grease fire. The burn hospital saved her life, but once she was discharged there was no follow-up. She was bounced back and forth between the burn hospital and her local hospital. Her head was pulled to the side as contractures formed, and she could not sleep because of the pain. Many phone calls later, we found a plastic surgeon to take on her case. But the road to recovery will be long and hard, and she is still in pain without access to a pain-control specialist.

A man came in with shrapnel lodged between the bones in his knee. Imagine walking on little pellets, with severe knee pain with each step. His Medicaid would pay for narcotic pain medicine, but he could not find an orthopedic surgeon to remove the shrapnel. Many months later he did have the surgery, and now he must be weaned off the narcotics.

Many such patients turn to the painkiller that is available to them and relatively inexpensive: Street heroin may cost less than OxyContin. It is easy to see why patients resort to this. They are desperate for relief, and unable to find care that is legal. Many are arrested. But nothing is done to relieve the cause that started them down this path. Now they are felons, and their lives often spiral downward.

New Jersey taxpayers spend $15 billion a year on the Medicaid system that fails so many. The real safety net is charity. Caregivers in our clinic are all volunteers, and charitable donations cover costs of about $15 per visit—far less than Medicaid costs. Under a proposed law, NJ S239, the state would assume malpractice liability for the practices of doctors who donate four hours per week in a charity clinic—including the surgeons, pain specialists, and psychiatrists that are not available under Medicaid.

Enabling more patients to obtain adequate pain care would be far more helpful than more bureaucratic paperwork for preventing addiction—and would save taxpayer money besides.