Op-Ed, Career Planning

Disability Insurance and Naloxone: An Intern's Perspective

A naloxone prescription can muddy the waters when applying for disability insurance as a young physician.

The email arrived during lunch break in my cohort’s Advanced Trauma Life Support (ATLS) course. Orientation for emergency medicine interns was just wrapping up, and I had tried to tie up the logistical ends that I could before my first ED shifts commenced in full force. The message read: “Your application for disability insurance hit a snag when we ran through your medical record. Can you tell me about a prescription for naloxone you got last year?”

At first, I was confused. Did my primary care provider send my insurance broker the wrong patient information form? I had never been prescribed opiates. In fact, as a 26-year-old budding physician, I had no preexisting conditions and took no medications whatsoever.

But then, memories of an American Medical Association conference came floating into mind.

Past Surgeon General Dr. Jerome Adams had come to Chicago to talk to American Medical Association student members about social determinants of health and naloxone. It was 2019, and the opioid crisis was in full swing. It would be several more months before Purdue Pharma and the Sackler family would reach an initial settlement with about two dozen states for their role in the opioid epidemic,1 but many public voices had deemed it critical to advocate for harm reduction. Dr. Adams’ mission in talking to us medical students was to ensure that as many of us as possible carried naloxone, equipping us to save a life outside of the hospital in case we came across an individual who had overdosed on opiates.

Convicted, I went home and marched into my local pharmacy to pick up some naloxone. I opted for the injectable medication, which cost $40 at the time, instead of the brand-name intranasal formulary that would have put me out nearly $200 (an expense I certainly could not afford as a medical student). The pharmacist seemed quite unaccustomed to providing naloxone to individuals without a prescription, but I proudly pulled up the executive order that enabled me to do so. She then hemmed and hawed a bit about giving me needles to go with the injectable formula, but I assured her that, as a medical student, I would be responsible and not hurt myself or others in the event that, say, I came across an individual who had overdosed on opiates on my walk home and actually had the opportunity to use the medication.

Eventually, I walked out of the drugstore with a paper bag, a vial of naloxone, and several sterile needle-tipped syringes. I deftly stuffed these into my backpack, and there they remained, untouched. In fact, the only time I pulled out that paper bag was when, a few weeks later, Dr. Adams unexpectedly came to speak at my own medical school. After his talk, I proudly reached into my backpack and showed him my naloxone. He posted a video of this on his Twitter account, a gentle reminder of why I did not go into public speaking.2

At any rate, there I was, on the day before my first shift as an EM resident, trying to be a responsible young physician and purchase disability insurance as I had been advised,3 yet utterly confused by how this had delayed my application for almost a month. As a healthcare provider, albeit an initiate to the field, I presume I am more health-literate than most of the population, so I wondered how my patients applying for insurance after having been prescribed naloxone would be able to navigate this system.

California’s Confidentiality of Medical Information Act specifies that healthcare providers and healthcare contractors must obtain written authorization before disclosing an individual’s medical information, with some exceptions.4 Insurance companies with a vested interest in a knowledge of clients’ medical health for the purpose of selling them policies must therefore obtain individuals’ consent before interrogating their health records to assess eligibility and the companies’ risk in selling an insurance policy.5 However, if consent is denied, approval of an application for insurance is very unlikely.

This kind of information sharing between direct clinical providers and insurance providers disincentivizes patients to seek care for stigmatized illnesses such as substance use disorders and mental illness, and potentially for individuals such as myself who would like to have access to naloxone, but may be wary of unintended consequences. Here, indeed, the role of harm reduction centers and other community providers of anonymized medical care for the treatment of stigmatized disease processes is reemphasized, and the necessity of programs such as the Naloxone Distribution Project is highlighted.6

Ultimately, I wrote back to the insurance broker, including a copy of the Surgeon General’s Advisory7 and a link to Dr. Jerome Adams’ Twitter post in an effort to rectify my medical record. I closed my laptop and shoved it into my backpack, alongside a brown paper bag that now contained the intranasal formulary of naloxone, which I received free of charge at a conference.6

As I headed back upstairs to take my oral ATLS exam, I wondered at the hidden medical curriculum and the information about personal liability, patient throughput, and scholarly productivity with which my cohort and I were about to be bombarded as inductees to the provision of emergency medical care. In a few short months, we will receive our drug enforcement agency number, and be able to prescribe medications to patients ourselves. A good amount of us will even apply for and obtain our first disability insurance policy. In the meantime, I will be keeping that little brown paper bag in my backpack, just in case.

Take-Home Points


References

  1. Opioid lawsuits generate payouts, controversy. American Bar website. Updated September 2019. Accessed July 3, 2021. 
  2. @surgeon_general. Glad to see @UCDavisHealth Medical Student, Dr. Asselin, is mission-ready to fight the #OpioidEpidemic and #SaveALife! She picked up #Naloxone from her local @cvspharmacy after hearing me speak at @AmerMedicalAssn! #GetNaloxone #EnableRecovery. Posted June 24, 2019.
  3. Dahle J. What You Need To Know About Physician Disability Insurance. The White Coat Investor - Investing & Personal Finance for Doctors website. December 25, 2020. 
  4. Cal. Civil Code § 56 et seq.
  5. Cal. Civil Code § 56.10(a).
  6. Naloxone Distribution Project Frequently Asked Questions. California Department of Health Care Services. Released December 2020. Accessed July 3, 2021.
  7. Adams J. U.S. Surgeon General’s Advisory on Naloxone and Opioid Overdose. U.S. Department of Health & Human Services website. Updated April 5, 2018. Accessed July 3, 2021. 

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