The United States has a prescription drug problem. Drug-induced deaths have been rising rapidly, and according to the National Center for Health Statistics now surpass deaths from firearms, suicide and homicide. Of those drug-induced deaths, opioid analgesics are implicated in more deaths than heroin and cocaine combined. The newspapers are full of stories of communities in decline from the growing prevalence of drug-dependency and associated crime.
In response to this growing problem, New York State has enacted a new law governing prescription drugs, called the Internet System for Tracking Over-Prescribing, or I-STOP. The key provision of the law, which goes in to effect on August 27, mandates that anyone prescribing controlled substances must first look up the intended recipient in online database maintained by the State Bureau of Narcotic Enforcement. That database, called the Prescription Monitoring Program (PMP) Registry, will have information on every prescription for controlled substances (Schedules II, III and IV) filled in New York. Providers are expected to document in their own records that they have consulted the database each time they write such a prescription. To access the database, you need an account. Information about how to obtain an account is available here. More information about the program is available here.
This is a big deal. I suspect that many of us are in for some unpleasant surprises, as we discover that some of our patients have been obtaining multiple prescriptions for similar – or not to be mixed – medications from different prescribers. Many physicians, seeking to avoid the hassle of checking the PMP, or concerned about how their prescribing habits may become visible to other physicians (and the State) may just stop prescribing controlled substances altogether. Both are likely to lead to tough conversations with patients. My guess is that the net result will be a precipitous drop in the number of scripts written for controlled substances in NY, which is pretty clearly what was intended. What is a lot less clear is the impact this will have on patients with legitimate needs for these drugs.
What do you think?