How America's Prescription Drug Addiction Crisis May Get a Whole Lot Worse
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New York's model, not Oklahoma's will almost certainly become the national strategy, because New York is the first state to take on the problem at the source, the doctor's office. For that reason doctors across America should take note of what's happening in the Empire State.
The Difference Between Oklahoma and New York
Oklahoma's state legislature passed the real-time law over two years ago, but the system didn't finally get up and running until January 2012. By that time, all 1,013 of Oklahoma's pharmacies were supposed to be reporting real-time data to the PMP, but only 300 actually were.
"The technology needs to catch up to the law. There are some medical clinics that haven't event got the electronics yet, most of the bigger ones certainly have. They're catching up to it," said Mark Woodward, spokesman for the Oklahoma Bureau of Narcotics.
It's too soon to tell whether Oklahoma's real-time requirement has had an impact on doctor-shopping, but the management differences between Oklahoma and New York shed light on the different philosophical approaches to prescription drug regulation.
In Oklahoma, the Bureau of Narcotics is in charge of managing the state's PDMP, unlike in New York, where it's managed by the Health Department.
"They both monitor Schedule II-V drugs. The big difference is the access and ability of the PDMP to be most useful to the health community. Oklahoma works extensively with their pharmacists. Truthfully, New York's requirement that prescribers access the database [as opposed to just reporting to it without checking a patient's history] is going to be more extensive," said Sherry Green.
Whereas New York's new law requires doctors to access the database before writing a prescription, and then immediately report the new prescription, Oklahoma only requires that pharmacists enter the prescription immediately after filling it. It doesn't address the problem of overprescription, only doctor-shopping. It doesn't put the burden on the doctors, it put the burden on law enforcement to go after people they suspect are doctor-shopping.
Should doctors police patients or should law enforcement? It's a rock and a hard place issue. While Oklahoma's solution is more akin to the traditional U.S. strategy of stopping drug abuse, New York's presents its own ethical dilemma.
MD or NYPD?
Some New York doctors say there are two related problems with the new requirements: 1) the system is too slow and will overburden them; and 2) the more fundamental problem: they're expected to police their patients, thus breaching the doctor-patient confidentiality agreement.
"The problem with the system [PDMP]is that it puts a burden on physicians to enter prescriptions into the registry. It takes anywhere from three to 10 minutes for each patient, so when you're evaluating and treating a lot of patients that's a lot of time lost," said Neil Nepola, a family physician with a practice on Staten Island, and president of the New York State Academy of Family Physicians.
The I-Stop law actually has two parts. The first is the real-time requirement by 2013. The second part of the law requires the State Health to implement a new, faster and more sophisticated electronic database by 2014.
Dr. Russell Portenoy, the chairman of pain management and palliative care at Beth Israel Hospital in Manhattan, believes these two parts of the bill are being rolled out in reverse order.
"What we've been trying to do for the past 25 years is talk about balance that says regulators and law enforcement people do need to address the problem of prescription drug abuse and diversion, but anything that's done needs to address that these are crucial medications for legitimate pain patients," said Portenoy.