A state database that tracks patient prescriptions in real time made its official launch on Tuesday, with the goal of cutting down on prescription drug abuse.
Under the state’s I-STOP law, passed last year, doctors are required to check a patient’s record before filling or issuing a prescription for a narcotic or other powerful drug.
Called the Prescription Monitoring Program Registry, the database will enable providers to see whether a patient has already obtained a prescription for a particular medication from another provider or has multiple prescriptions of different drugs. The idea is to alert providers to red flags that could indicate that a patient is abusing medication or obtaining it with the intent to sell it or give it to others.
Dr. Charles Argoff, who directs the Comprehensive Pain Center at Albany Medical Center, said he was optimistic that the database would cut down on addiction to prescription drugs.
“Given that the No. 1 source of misused and abused opioids comes from a legitimate prescription, how can we not institute a system that allows providers to know in real time who is prescribing what?” Argoff said. “We have a significant issue that has to be addressed that involves increasing mortality and morbidity associated with prescription drug use and misuse.”
Some physicians have expressed concern about the new database.
In an op-ed article earlier this year, Dr. Jeffrey T. Berger, who heads the Medical Society of New York’s Bioethics Committee, wrote that “the legislation risks a number of unintended consequences to the detriment of patients and to medical professionalism.”
“Under the I-STOP law, physicians must presume that every patient is guilty of medication abuse until cleared by the database,” Berger wrote. “Never mind that patients can circumvent the database by filling prescriptions in the neighboring states of New Jersey, Connecticut, Massachusetts, Pennsylvania and Vermont.”
Argoff said he hopes his fellow physicians will give I-STOP a chance.
“Yes, it’s going to be a change,” he said. “It will take time for practices and practitioners to get into a good rhythm about how to do this.”
Pain management specialists such as Argoff help patients find ways to relieve their pain and also reduce their dependence on opioids such as hydrocodone and Oxycontin, a class of drugs better known as prescription painkillers.
Pharmacists are required to submit data to the registry but not to check it before filling a prescription.
In the past, they’ve submitted patient data to the state once a month; under I-STOP, they will submit this data every day, said Tracy Russell, executive director of the Pharmacists Society of the State of New York. “This is something pharmacists have always done,” she said.
Russell said that the law “adds time” to the workload of pharmacists but added that the pharmacist doesn’t necessarily have to be the person who deals with the database paperwork. There are other employees, she said, who could handle that part of the job.
The system that hosts the Prescription Monitoring Program was down for about 30 minutes Tuesday to allow for system upgrades, according to Jeffrey Hammond, a spokesman for the New York State Department of Health. “The upgrades are now complete and the system is functioning,” he said.
Russell said that her organization had received some phone calls from pharmacists seeking information about the database, but overall, its first day of operation had gone smoothly.
In recent years, addiction to prescription painkillers has exploded.
According to a 2012 U.S. Centers for Disease Control and Prevention policy brief, drug overdoses have more than tripled since 1990 and have never been higher. In 2008, more than 36,000 people died from drug overdoses, most of which were caused by prescription drugs, specifically opioids.
The New York State Department of Health rolled out the new Prescription Monitoring Program Registry on June 12, but its use wasn’t required until Tuesday. So far, providers have performed 138,436 individual searches for 127,552 patients.
I-STOP, also known as the Internet System for Tracking Over-Prescribing, includes a number of measures intended to combat prescription drug abuse.
It removes hydrocodone from the less restrictive Schedule III category and places it in the more restrictive Schedule II category. Hydrocodone is the most prescribed controlled substance in New York, with more than 4 million prescriptions created each year over the past four years. The rate of prescribing hydrocodone has decreased at an accelerated rate since the enactment of I-STOP, according to the DOH.
I-STOP has also created a safe disposal program for prescription drugs.
The DOH, in partnership with the New York State Office of Alcoholism and Substance Abuse Services and the New York State Police, has established secure disposal sites for controlled substances at police stations throughout the state. People can voluntarily surrender controlled substances at these sites.
In addition, electronic prescribing of controlled substances is now permitted in New York and will become mandatory in 2014. According to the DOH, “strong encryption standards” will ensure that electronic prescriptions are authentic and eliminate the opportunity for forgeries and stolen prescription pads.
There are some exemptions to the Prescription Monitoring Program Registry requirements.
For example, prescriptions written in an emergency room setting and for no more than five days do not have to be logged into the registry.
I-STOP is administered by the DOH’s Bureau of Narcotic Enforcement.