New York State Set to Crack Down on Painkiller Abuse

New York's new strategy for reducing abuse of prescription painkillers includes requiring pharmacists to immediately report all prescriptions filled for controlled substances.

New York State is poised to establish some of the strongest safeguards in the nation against prescription painkiller abuse. The state’s governor, Andrew Cuomo, and legislative leaders have announced an agreement toward this end that includes enhanced monitoring and oversight of prescription and dispensing of controlled substances. As part of the plan, pharmacists will for the first time be able to consult a registry of controlled substance prescriptions before dispensing medications to patients.

The centerpiece of the plan is an advanced prescription monitoring program called I-STOP, whose goal is to limit the ability of “doctor shoppers” to get prescriptions from multiple doctors. It would feature a registry that would be required to be updated in real time by physicians when they prescribe controlled substances and pharmacists when they dispense them. In addition, physicians would be required to check a patient’s medication history in the registry before prescribing or dispensing a controlled substance. According to the Associated Press, most states require doctors to report controlled substance prescriptions weekly, while Oklahoma has instituted real-time reporting by pharmacists.

The new plan would require controlled substances to be prescribed electronically, with some limited exceptions. The plan’s sponsors argue that e-prescribing will prevent drug diversion resulting from alteration, forgery, or theft of paper prescriptions, and reduce medication errors due to misinterpretations of written prescriptions. The plan would also tighten regulation of medications containing hydrocodone by elevating it from a Schedule III to a Schedule II drug. This would eliminate automatic refills and limit prescriptions of medications containing it to at most a 30-day supply. (A 90-day supply would be allowed for patients with chronic pain and a few other exempted conditions.)

In addition, the plan aims to improve awareness of prescription drug abuse among prescribers through expanded education and increase opportunities for patients to safely dispose of unused pills to address the fact that a significant portion of abused prescription medications are obtained from friends or relatives.

Governor Cuomo has made passage of the plan by the end of the legislature’s current session later this month a priority. Provided it becomes law, the associated regulations could be completed by the end of the year and the new controlled substance prescription registry could be running by next year, according to New York Attorney General Eric Schneiderman.

“This landmark agreement will help put a stop to the growing number of fatalities resulting from overdoses on prescription drugs,” Governor Cuomo said in a statement. “We have seen too many untimely deaths as a result of prescription drug abuse, and today New York State is taking the lead in saying enough is enough.”

Some physicians have argued, however, that the new requirements would be time-consuming and burdensome and could prompt some doctors to withhold painkiller prescriptions from patients who need them. In addition, 5 pharmacy organizations recently registered their disapproval of an effort in Congress to elevate hydrocodone-containing painkillers from Section III to Section II drugs, arguing that doing so would reduce access to the drugs for those who need them and increase costs without any guarantee of keeping them out of the hands of abusers.