Controversy in New York Over Potential Prescription Drug Monitoring Program

An ambitious plan to reverse New York’s growing prescription drug epidemic is causing a rift between legislators and health care providers, pitting a proposed computer system that would require doctors and pharmacists to meticulously scan patients’ medical history for patterns of abuse against arguments by two professional associations that increased monitoring would backfire.

New York Attorney General Eric Schneiderman’s Internet System for Tracking Overprescribing (I-STOP) bill, unveiled last year, would connect prescribers to a centralized online database that tracks frequently abused controlled substances in real time. It would help physicians avoid over-prescribing by requiring them to review patients’ prescription history before they issue a new prescription, and pharmacists to check the database for script authenticity before they dispense painkillers. It would also mandate that doctors and pharmacists report new prescriptions every time they are written and filled.

The bill is endorsed by U.S. Senator Kirsten Gillibrand, a bipartisan coalition of state and local legislators, law enforcement and medical professionals, and most recently the New York chapter of Treatment Communites of America, an association of providers serving people with substance abuse issues. New York state ranks 11th in the nation for admissions to chemical dependence programs for abuse of opioids other than heroin.

“The Attorney General’s I-STOP plan will help law enforcement and the medical community combat prescription drug abuse to prevent tragedies from happening in the future of Long Island and across the state. There is no good reason to deny doctors and pharmacists the ability to make controlled substance dispensing decisions on an immediate and real-time basis,” said Nassau County District Attorney Kathleen M. Rice in statement on the AG’s website.

Nassau and Suffolk counties are among the regions hit hardest by addiction-related crime, overdose and death, according to a recent report released by the attorney general. From 2007 to 2010, prescriptions for oxycodone (the main ingredient in OxyContin) increased 82 percent in Nassau County, and the painkiller has contributed to more deaths than any other prescription opioid there since 2006, the report says. In December, an armed robber held up a pharmacy in Seaford, demanding OxyContin and cash, and was killed along with the off-duty federal agent who tried to stop him. Last summer, a pharmacy shooting in nearby Medford made national headlines when a robber killed four people before escaping with thousands of prescription painkillers.

Statewide, painkiller prescriptions increased by six million, or from 16.6 million to 22.5 million between 2007 and 2010, according to the report. In New York City alone, nearly 900,000 oxycodone prescriptions and more than 825,000 hydrocodone prescriptions were filled in 2009, the city’s Department of Health and Mental Hygiene has reported. Prescription drug trafficking, lack of training and communication between specialists treating the same patient, and easy access to drugs facilitated by crooked doctors, street-level drug dealers, and doctor-shopping addicts are widely blamed.

Despite the scope of the crisis, the Medical Society of the State of New York, which represents 30,000 physicians, is opposing the bill. In a petition on its website, the group says it agrees with the goal of the legislation, but argues that mandatory patient record checking, prescription reporting, and penalties for physicians who fail to do so would create undue administrative burdens for doctors. Currently, there is no tracking of prescriptions written.

“We all agree that medications are being abused and diverted. What we’re concerned about is that if there are too many mandates or if they are too strict, it would create such a burden on physicians practices that some physicians would choose to stop prescribing,” said Frank Dowling, MD, commissioner of public health and science for the medical society and co-chair of its Committee on Addiction and Psychiatric Medicine, in a telephone interview.

“What’s missing in this discussion is that there are many patients with chronic pain and doctors are being asked to prescribe more painkillers because patients are being undertreated,” Dowling said. He noted that in some counties there are no pain specialists at all and patients often have to travel or wait for months to see one.

Dowling’s statement is supported by findings in a major Institutes of Medicine (IOM) report on chronic pain, in which researchers say acute and chronic pain affects at least 116 million Americans, not including children. For many of them, treatment is inadequate because they lack a clearly defined diagnosis of illness, such as cancer, heart disease, or physical trauma, that “legitimizes” their pain to prescribing physicians, causing them to seek alternative routes to supply medications.

On the other hand, patients who use painkillers for a non-medical purpose – for the “high” they cause – would likely become less forthcoming if physicians are required to report every prescription they write for them, making it even harder to identify and report signs of potential drug abuse. “There’s a lot of stigma in seeing a psychiatrist and getting an addiction treated. [With I-STOP] patients would be even more intimidated,” Dowling said.

Instead, he suggests the system that’s already in place should be improved. A voluntary prescription drug monitoring program run by the New York State Department of Health does exist, but is unpopular, time-consuming, and updated irregularly. It has been made accessible to physicians, though not to pharmacists, only in the last two years, and many doctors are not educated about its availability and usefulness.

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