How America's Prescription Drug Addiction Crisis May Get a Whole Lot Worse
Pills in Hand
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This summer, New York state passed legislation that aims both to prevent patients from doctor-hopping to stock up on prescriptions and to deter doctors from overprescribing controlled medications. The rest of the nation may emulate the new law, but the data that is supposed to be the backbone of the policy may very well be insufficient. Instead of reducing prescription pill abuse, these new regulations may prevent the people who need meds from getting them.
On June 11, New York State Governor Andrew Cuomo signed off on the I-Stop bill, which will require doctors to check a patient's medical history in an electronic database before prescribing Schedule II, III, IV and V drugs by summer of 2013.
It covers all the pills you could potentially take either to cope with a crippling medical condition or to party with: oxycodone (Oxycontin, Percocet), hydrocodone (Vicodin, Lortab), the vast family of benzos (Xanax, Klonopin) and most amphetamines (Adderall, Ritalin).
While most states, including New York, already have these electronic databases, New York is the first to require doctors to actually check them before prescribing, and then report the new prescription into the database immediately after writing it. The goal is to help doctors know whether a patient has been going from doctor to doctor in search of multiple prescriptions, and also to prevent doctors from overprescribing.
Overprescribing doesn't mean that a doctor is handing out unnecessary prescriptions; it means that a doctor is prescribing a patient more pills than they really need. Problems can occur when a patient ends up with extra pills sitting in the medicine cabinet.
New York State Attorney General Eric Schneiderman called it a model for other states to adopt. It probably will be.
Since prescription drug abuse became a national epidemic, states have been rapidly trying to fnd a model to reduce overdose deaths, and New York is the first state to really take on the problem at its source in an aggressive way, much to the chagrin of many doctors.
"The trend is to move to real-time reporting of prescriptions," said Peter Ashkenaz, a spokesperson for the U.S. Department of Health's Office of the National Coordinator for Health Information Technology, which is currently helping Ohio and Indiana implement a prototype to grant real-time access to their electronic databases.
That said, New York's new law is very much a prototype. Little is known about how effective it will be or what negative, unintended impact it's going to have, and for that reason it's both fascinating and worrisome. That so little is known is partially because the one organization comparing different states' prevention techniques hasn't released the findings of its seven-year-long research project. It's also simply because of how uncharted this regulatory territory is in the United States.
To really understand the significance of New York's law and its impending adoption by other states, you need to look at its historical context.
In the late '90s and early '00s, prescription drug abuse was a decidedly rural problem in the American consciousness. Now, it's everyone's problem. A familiar narrative if you've been following drug news in the past five years.
Due in part to weak regulatory oversight, a lack of education among both doctors and patients and unscrupulous drug company practices, prescription pills surpassed meth as the national drug scourge. In New York City, new prescriptions for oxycodone doubled between 2007 and 2010, said the city's special narcotics officer, Bridget Brennan. By 2009, drug overdoses had replaced car accidents as the leading cause of death due to unintentional injuries, and the vast majority of those overdoses were due to pain pills like hydrocodone and oxycodone, according to CDC statistics.