A mounting death toll from prescription drug abuse has vaulted narcotics like Oxycontin to the top of this year’s Albany agenda, but the state legislature is now deeply divided on how to respond.
As pharmacies continue to fill forged prescriptions by the tens of thousands, a proposal advanced by Attorney General Eric Schneiderman for a comprehensive electronic tracking system is running into fierce objections from doctors and pharmacies, including chains like CVS and Walgreens. While a bill based on Schneiderman’s proposal sits in the State Senate’s health committee, its chair, Kemp Hannon, is advancing a set of more modest reform proposals favored by the industry.
Pharmacies in the state filled more than 7.75 million prescriptions for oxycodone and hydrocodone last year, almost a million more than in 2009. An untold number of those prescriptions are fraudulent, originating with forgers like Suzanne Benizio of the Bronx. Last week, a state judge sentenced Benizio to prison for up to eight years for trading in stolen prescriptions for OxyCotine and other narcotics, and to refund more than $211,000 in Medicaid funds to the state. She had been the ringleader of a drug operation that forged more 250 prescriptions stolen from hospitals around New York. Benizio filled out the forms in the names of Medicaid recipients, then presented the slips to pharmacies.
Schneiderman asserts that his proposed tracking system, called I-STOP, or Internet System for Tracking Over-Prescribing, would preempt schemes like Benizio’s, by requiring doctors and pharmacists to report and review prescriptions in real time. That would make schemes like Benizio’s virtually impossible, because the system would immediately flag when the same patient sought multiple prescriptions simultaneously. It would also prevent so-called doctor-shopping, in which individual patients obtain multiple prescriptions to feed their addictions.
“From doctors and patients to law enforcement officials and legislators, bipartisan support continues to grow for Attorney General Schneiderman’s I-STOP plan to build an online database that addresses the prescription drug epidemic in real time and replaces the broken system now in place,” said Jennifer Givner, a spokesperson from Schneiderman’s office.
The bill based on Schneiderman’s proposal accumulated sponsorship from 33 state senators, almost enough to pass. But it must first get through the Senate Health Committee, whose chair, Sen. Kemp Hannon (R-Garden City), has pushed his own alternative measures favored by doctors and pharmacies. Prescription drug abuse is a must-act issue for Hannon and other legislators on Long Island, where in June an addicted gunman shot and killed four people in a pharmacy in Medford, then stole 10,000 hydrocodone pills.
Schneiderman has signaled he won’t settle for less than a complete overhaul of a system his office has called “outdated with regard to how and when data is collected, who has access to it, and how it is used.”
Last Monday, Hannon convened a panel of regulators, doctors, parents and politicians for a roundtable at the State Capitol, then introduced a package of four bills of his own. Later that afternoon the full Senate approved the measures, which increase criminal penalties to physicians and pharmacists found illegally issuing prescription drugs and enforce stronger monitoring at pharmacies of the most addictive painkillers, such as oxycodone. High-grade prescription drug sales to minors, would be criminalized, and pill mills would have to be investigated more thoroughly.
Hannon released a white paper late Wednesday afternoon that cautions against too-aggressive intervention. “There is no ‘quick fix’ for this crisis,” the report concluded. “We must make prompt, but incremental change to correct flaws in the current system.” Without Hannon’s support, it’s unlikely I-STOP will get to the Senate floor for a vote.
Senator Hannon said in an interview that he would review all the current legislation in play and come up with an appropriate plan – but not a real-time database. “We have an existing system,” he said. “But I am committed to getting out legislation within this session.”
That last sentiment echoes through the Capitol. On Wednesday, Gov. Andrew Cuomo issued a public statement pleading with both sides to come to agreement on a solution. “My administration is committed to working with the Senator, Attorney General Schneiderman and key stakeholders to address this issue and stem the tide of crime and drug abuse that has been caused by the illegal distribution of prescription drugs,” said Cuomo.
Senator Hannon is not alone in his opposition to the proposed database: Doctors’ groups, consumer organizations, pharmacies and even some prosecutors take issue with it.
The Medical Society of the State of New York, a trade association for doctors, has warned that I-STOP would place heavy new burdens on practitioners. Last year it spent more than $1.2 million on Albany lobbying, and this year the organizations is likely to spend much more in its effort to make sure Schneiderman’s measure does not pass the legislature, says society vice president Morris Auster. “Our doctors already work very hard,” said Auster. “I-STOP would mean most clinics would be forced to hire an extra person to take care of data entry.”
When I-STOP was first introduced last session, it drew opposition from the Pharmacists Association of New York City and New York State, which spent $155,398 on state lobbying last year, and the Chain Pharmacy Association, whose lobbyists billed for $62,198 in fees. AARP, the Retail Council of New York, pharmaceutical company Eisai and even Mastercard and AOL have all had their lobbyists weigh in on the regulation of pain medicine prescriptions and sales.
Opponents of Schneiderman’s I-STOP proposal system want to improve on – but not replace – an existing database, called the Prescription Monitoring Program, through which pharmacies report information on prescriptions for controlled substances. These transmissions are sent to the federal Bureau of Narcotic Enforcement each month. Although the database is an important tool for curbing fraud, New York is one of the only states in the U.S. where pharmacies are only required to file once a month instead of daily or weekly, or even in real time.
It’s a time lag that destroys lives, according to Bridget Brennan, special narcotics prosecutor for the City of New York, who handles more than 3,000 cases a year. “Those extra days mean that the data we’re trying to work with is almost always out of date.” Brennan lamented. “And investigations are often compromised.”
Brennan’s own caseload shows the epidemic in force: prescription drug investigations now account for one-fourth of her entire budget, and in just the last two years her caseload for prescription drug prosecutions has increased from about 65 to more than 200 cases. Similarly, statewide the number of investigations annually has tripled since 2009, to 2,270 last year.
Yet while Brennan thinks Schneiderman’s proposal is a good idea, she would prefer to see other measures put in place first. “I see the advantages to I STOP, but really the issue calls for more urgency.” she said. “We need real-time reporting within 24 hours, that should be entered into the system as prescriptions are filled. Pharmacists should have full access, and they don’t.” All this, says Brennan, could be accomplished right now by tinkering with the existing system.
Also concerned about the impact are advocates for patients who may find it more difficult to obtain medication they’ve been prescribed, especially if I-STOP technology turns out to be imperfect. Said Blair Horner, Vice President of the American Cancer Society, “It’s always an issue of how to balance keeping the criminals out without creating obstacles for people who really need medication.” Another consideration, Horner notes, is cost: the attorney general projects the integrated database could cost anywhere between $4 million and $23 million over the next decade.
Arthur Levin of the Center for Medical Consumers, an independent nonprofit, calls the plan “pie in the sky” and a “waste of money.”
“The AG’s proposal imagines a world that doesn’t exist,” he said. “In this world there is a real-time ability to take a look behind the curtain and find out what a person is taking!”