Narcotics, Pain, and Medicaid in New Jersey

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By Alieta Eck, MDhttp://zhcenter.org

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.


Dr. Alieta Eck graduated from the Rutgers College of Pharmacy and the St. Louis University School of Medicine in St. Louis, MO.  She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988, affordablehealthinc.org.  She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care.

  • Dr. Eck testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver medical care in the United States. In 2011, she testified before a Senate Health Committee chaired by Senators Bernie Sanders and Rand Paul– about ways to avoid non-urgent visits to the emergency rooms.
  • In 2003, she and her husband founded the Zarephath Health Center, a non-government free clinic for the poor and uninsured that currently care for about 300 patients per month utilizing the donated services of volunteer physicians and nurses. It is only open 12 hours per week. zhcenter.org
  • She is working to pass NJ S239, a bill that would provide medical malpractice protection for the private practices of physicians who donate 4 hours per week in a clinic like the ZHC. njaaps.org
  • Dr. Eck was the 2012 President of the Association of American Physicians and Surgeons and serves on the board of Christian Care Medi-Share, a faith based medical cost sharing ministry.
  • She was the Republican nominee for the US Congress for NJ12 in 2014.
  • In March, 2015, she chaired a meeting of the National Physicians Coalition for Freedom in Medicine, about 30 physicians, who gathered in Washington, DC to draft a “One-Page Plan” to restore affordability, promote patient choice and retain quality in medical care. https://aaps.wufoo.com/forms/m11okp2x1yjc8qf/
  • Dr. Eck spoke at the National Press Club in Washington, DC in June, 2016 to help unveil the Wedge of Health Freedom, an initiative of the Citizens’ Council for Health Freedom, with President Twila Brase.  JointheWedge.com

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  • Anne Fuqua

    You guys are true heroes for what you did to help these patients. Just thinking about what they went through makes me so angry!

  • Sean Dineen

    Dr. Eck’s kindness and vison is unparalleled

  • Pam

    It is INHUMANE and barbaric the way legitimate chronic intractable pain sufferers are being treated! The corrupt government and thier sidekicks, the DEA, CDC AND FDA are committing genocid thruout the pain community! Because of the actions by the DEA, drs are denying legitimate pain pts the lifesaving pain medication they require to sustain a QUALITY OF LIFE! Ten long years I have been battling debilitating incurable diseases that cause severe pain. I have gone thru all the alternative therapies my body could take and I could not afford! I was put on many medications that did not work and gave me horrible side effects. Opiods were the last resort, like it is for nearly all chronic intractable pain pts, unlike what the government is preaching to the public! Once we found what worked for me i was given a QUALITY OF LIFE! I was on the same stable dose for eight years with success, my pain was at a tolerable level! About 18months ago my dr lowered my meds to ineffective doses and took some away. I no longer have a QUALITY OF LIFE! For the last few months he has made degrading comments at me and last month told me to think about going to detox, i AM NOT AN ADDICT! I have ten years worth if medical records documenting all my debilitating incurable diseses! Chronic pain pts are being abused, mistreated, neglected, degraded, discriminated against, and are being forced to suffer!! Many are turning to the streets for relief and many are committing suicide to escape the pain!!! Chronic pain pts need help now, how many more suicides will it take!?

  • patgo

    This is just a few of the MANY ways the government system fails patients. When a close relative had a stroke, the surgery was excellent, but it was downhill from there. The doctor put him on FOURTEEN medications behind our backs and AGAINST OUR WILL. When he had respiratory failure, they blamed HIM and kept right on giving him the medications, including one SPECIFICALLY REJECTED. It totally messed up his immune system. He had THREE bouts with bacterial disease while in the hospital, including pneumonia and MRSA in the lungs, his hospital stay was prolonged by weeks, his rehabilitation was seriously prolonged, he lost most of his muscle mass and had to rebuild it, and when he passed the test to have the tracheostomy cannula removed, they refused to do so, prolonging the incessant coughing and mucus (which stopped within 24 hours of removal, which ALSO happened without all the horrible things they terrified him with). We had to invoke the Patient Bill of Rights to get it removed and were forced to sign a waiver of liability! And then when he developed bullous pemphigoid, the insurance company REFUSED to pay for a COMPLETE course of medication to wean him properly from prednisolone. That meant to do it the way the doctor wanted would have cost an additional $271, to people with no income but Social Security. And we don’t even know if he will suffer other repercussions. It has been an absolute nightmare! I complained to an organization that evaluates hospital treatment, and in the case of all three hospitals, they found that the standard of care had been observed. SINCE WHEN IS GIVING ANYONE FOURTEEN MEDICATIONS ALL AT ONCE even REMOTELY good care? He was totally medication-naive. They should have known better. At least 10 of those medications were strictly prophylactic, and seven of them can cause breathing problems. A really powerful medication had to be given against national protocols, another was given for a condition he never had in the past, and three others were given in a situation where the outcome is the SAME whether treatment is undertaken or not. HELLO?

  • L. Brody, MD

    Easy solution. Why become a potential criminal. Refer all patients in pain to a pain specialist. Expensive but avoid the risk of criminality as society seeks scapegoats in treating physicians. It is hard to find pain specialists as they may want to be cautious.
    Risk to physicians is climbing and is it necessary to have protective legislation to take care of people competently and ethically?????

    The unintended consequences of government protection.

    https://mises.org/blog/when-government-acts-unintended-consequences-follow

    • Pam

      Do you really think it’s that easy for a chronic intractable pain sufferer to get in with a pain specialist? !?! Good Lord you are out in LA LA land. Pain pts are being abandoned by thier drs, pain drs are leaving tge profession in droves. When someone suffers intractable pain it’s pain that will never go away caused by diseases that are DEBILITATING AND INCURABLE AND WILL WORSEN OVER TIME. Nearly all chronic pain pts have tried all the alternative therapies their bodies could take snd wallets could not afford. We gave been put thru every injection, therapy, massage, chiro, accupuncture, failed spinal fusions, water therapy, exercise, eating healthy, steriods, discographies, discetomies and so much more. Opiods are our last resort and finally the gates have opened up and we get a QUALITY OF LIFE! WE all tolerate pain and medication differently. The government treating lifesaving pain medication as a one size fits all is devastating. Many legit pain pts are having to turn to the streets for relief or worse SUICIDE! . Pain ctrs want nothing to do with the chronically ill due to the fact many require opiods to sustain a QUALITY OF LIFE and drs are running scared to prescribe, no thanks to our corrupt government and thier sidekicks the DEA, Cdc, FDA AND PROP. People are dying at tge hands of the government =GENOCIDE! ! ,Where’s the outrage and media reports that the government is torturing and murdering American chronically ill citizens! !

  • GoldenAutumn

    Thank you for acknowledging the legitimate pain issues. As one who cannot take tylenol due to an allergy; cannot take NSAIDs any longer due to them creating an duodenal ulcer that flares up each time I try to take one single low dose until I was told I could not take them at all because it has to do with the chemicals of the medication getting into the blood and causing flareups. due to a severe IgA deficiency from a splenectomy, I cannot take the typical meds used for people with my disease. All we do is treat the pain which is directly linked with the disease. I eventually found a doctor who believed me and after trying other methods, we resorted to the appropriate meds. I have not abused them and in fact, don’t like having to take them but I am grateful for them because they have allowed me to live a so-called normal life. There are some of us out there who genuinely need these, who have tried all the other routes but have no other recourse in order to live as we can. And what I wish our government, the insurance companies and the medical field would understand is that we don’t all abuse them!! In an effort to regain my health, I have looked into the alternative medicine and found great help and aid in treating my disease which has in turn helped the chronic pain. I’ve been able to cut my intake in HALF and more! Suffice it to say, my doctor and I are thrilled. If our insurance companies would simply get out from under big Pharma’s control and acknowledge that toxic drugs to treat autoimmune diseases are not the answer! My sister in law died from the side effects of her RA immunosuppressive drugs. Is that any way to live knowing that the drug has this potential to give you another disease like CANCER? Thanks but no thanks! Those toxic drugs act as a band aids while the side effects kill us. We can learn a great deal from the alternative medicine field who has a grip on autoimmune diseases, people like Russell Blaylock, retired neurosurgeon. I am a living testimony to the fact that the alternative really WORKS!

  • tobyw

    There is much work needed in healthcare even after ACA is gone. Who monitors the doctor who allegedly mis-prescribed fourteen medications as patgo says? Is anyone responsible?

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