New I-STOP Law

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?

6 thoughts on “New I-STOP Law

  1. Thanks for your thoughts. Another database? Although this is seemingly a good thing, I’m surprised physicians have to register and take yet another step before prescribing. I knew of similar information being displayed in Lipix/Healthix (free) database and possibly the EMR. In your view, is requiring docs to go to yet another website a good idea? Will it work or be perceived as another barrier?

  2. I for one think that mandating the use of a state prescription-monitoring program is a good move. The majority of states that have them and used them effectively have reaped the benefits including ensuring that access to substances is for legitimate medical uses,and identifying, deterring abuse and diversion. In addition the data from the use of such programs, informs public health initiatives by outlining the use and abuse trends of controlled substances and diversion of and addiction to prescription drugs. The available evidence suggests that monitoring programs are effective in reducing the time required for drug diversion investigations, changing prescribing behavior, reducing “doctor shopping,” and reducing prescription drug abuse. However, as you suggest, research on the effectiveness of these programs is limited and assessments of effectiveness need to take into consideration potential unintended consequences, such as limiting access to medications for legitimate use or pushing drug diversion activities over the border into neighboring states. As for the impact on legitimate users there is no data to support that patients who need controlled substances are not getting the medications they need.

    I used a similar program in Kentuckywhen I practiced at the University of KY in Lexington, KY, a state with a far worse problem with prescription drug use than many others in the US. As a physician I found the program easy to use and it empowered me to have many crucial conversations with patients. As good as these programs are however, they represent only one part of a multi pronged approach to patients with prescription drug abuse. We need to adopt specific practice procedures that ensure accountability for providers as well as patients using contracts and multidisciplinary teams to treat patients with chronic pain and other conditions that require psychoactive drugs. Initially the challenge for providers is to develop workflows that incorporate iSTOP into patient care.

    1. Thanks for your comments and for sharing your experience with the system in place in Kentucky. I agree that it is hard to imagine that a database like this would work if it were not comprehensive or compulsory, both of which require that it be run by the State. I hope that the DOH and the BNE have plans to make the data that will be generated by this “experiment” available to health services researchers so that we can all learn how best to address the important challenge of prescription drug abuse and diversion.

  3. Though I have always thought that a program from the state was long overdue, there were much easier ways for this to have been implemented. When I used to work in an inner city medical clinic I used to be called from the pharmacy if I had a patient who had multiple prescriptions from other doctors. One call from the pharmacy was all it took for me to tell the pharmacy not to honor the presciption and to tell the patient to come back to the clinic if he/she had a problem. Rarely did they come back to contest me and a note was written in the chart to this effect. Also I received letters from medicaid on patients that they suspected of doctor shopping listing the patients drug history . As we frequently get from pharmacies notification of potential drug interactions , they could notify us about potential doctor shopping/drug abuse of our patients as they are the keeper of the drugs. In fact as a lot of us are now anyways to esubscribe a two way interaction between our pharmacy and our computer should flag us to any problems with our patients drug history. Having to go to another website is reduntant.

  4. I agree that is seems like a burden to check a separate electronic system each time you write a script for a controlled substance. I like the concept that you describe, where eprescribing would automatically do the checking for you, and provide the information through the system that you use to write the script. I suspect that it was a lot easier for the State to create a new mandate (and thereby increase the workload for physicians) than it would have been for them to address the technical challenges associated with automating some of this. In fact, that seems to me to be a pretty common theme — electronic systems that often increase time demands on physicians instead of making life easier. I can only hope this is a function of “immature” electronic systems that will eventually make practice easier, not more burdensome.

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