DEMOCRACY
STARTS WITH YOU.
ONLY /mo.
Caribbean L 58 ife, June 21–27, 2019
OP-EDS
Policies that hurt Sickle Cell Disease
room care, to outpatient care, to pharmacies.
For example, one SCD patient
working with one pharmacist for over
six years never encountered an issue
receiving her standard opiate regimen.
After moving to another town, she was
unable to receive her usual opiate regimen;
the new pharmacist expressed a
lack of comfort dispensing that same
opiate regimen. As a result, she suffered
a pain crisis and was hospitalized
while her prescribing physician worked
to resolve the issue with the new pharmacist.
Sadly, her story is typical of the
care SCD patients receive in the face of
the government’s attempt to stem the
tide of the opioid epidemic.
According to New York State Public
Health Law, providers can only provide
a seven-day supply of opiates for those in
acute pain, with exclusions for patients
with chronic pain, cancer, and palliative
care regimens. A SCD patient’s acute
pain flare-up does not fall neatly into
these categories. Providers must exercise
sound judgment to assess whether
the acute pain crisis is due to a larger
chronic disease and therefore requires
more than a seven-day supply, as it frequently
will with SCD. Providers also
need additional training in SCD treatment,
as many do not realize that it
currently falls under a palliative care
regime. Thus the seven-day supply limit
should not apply to patients with sickle
cell disease.
The efforts to limit the supply of
narcotics have had unintended consequences.
In order to avoid opiate overprescribing,
medical prescribers are
encouraged to limit the distribution of
narcotic medications. Providers should
not adopt policies that ultimately punish
vulnerable populations such as
those born with SCD. It is a condition
that is prone to lifelong pain with acute
episodes overlying the chronic state. As
an analogy, the medical system would
not limit the pain medication provided
to a third-degree burn victim. The provider’s
analysis of the injury and necessary
care would have her conclude
that the burn will not heal in seven
days; thus, the patient would require
an additional supply of pain medication.
Some healthcare professionals
need prescribing limits imposed on
their practice. But, prescribers must
also use clinical judgment and common
sense. They must recognize that
prescribing opiates to those with acute
pain is not as simple as applying a
rule in black-or-white, especially when
these rules create unintended consequences.
Policies and guidelines are
made “for all” but can harm those
patients who meet exceptions to the
rule and who are sometimes the most
defenseless and least able to fight for
themselves.
The healthcare delivery model for
SCD patients must be comprehensive,
adjustable to the needs of the patients,
and most importantly, empathic. Providers
must understand that SCD
patients ultimately suffer in three
ways — the pain and complications
of the condition, the maltreatment
from healthcare providers, and the
unintended consequences of reduced
opioid prescribing policies. It is important
to realize that NY State recommendations
do not apply to those
who fall under palliative care such as
those with SCD. Healthcare professionals
can work closely with sickle
cell community-based organizations
(CBO) to improve the experience for
SCD patients, advocate for increased
government funding for the disease
but also to lobby NYS legislature to list
SCD as an excluded condition under
the law.
The promise of a cure for sickle
cell is exciting. Cautious optimism
is warranted as the benefits may be
years down the line. In the meantime,
providers should consider how current
pain policies affect this vulnerable
population. Providers must use their
judgment and not their biases when
treating SCD patients to live up to the
physician’s creed of “Do No Harm.”
Dr. Tartania Brown is a palliative
care specialist who has sickle cell disease.
She works for Metropolitan Jewish
Healthcare System. Dr. Lyndonna
Marrast is a physician-researcher and
an advocate for sickle cell patients.
Continued from Page 10
Guyana prepares for fresh elections
But as the PPP revels in its victory
and as the coalition tries to recover,
controversy could loom if the two sides
failed to agree on the way forward after
this week’s ruling as a series of consequential
orders, stemming from the
landmark judgement looms.
The courts have given the politically
warring parties until Monday to agree
on these orders, especially as it relates
to the elections chief and how and when
the country should prepare for fresh
elections as the motion had validly toppled
the administration.
The coalition and the commission
have been pushing for a fresh round of
house to house registration to update
the voters list. It is unclear how long the
CCJ would give authorities to complete
that exercise and agree on a date for
fresh polls. With its current timetable,
the commission has said that it would
be ready for elections after the end of
November. The CCJ could compress
this as a compromise to both sides.
Continued from Page 14