New York's Opioid Prescription Monitoring System Needs Improvement

By Paul Gaita 11/27/18

The newly re-elected State Comptroller has found some major issues with the opioid prescription monitoring system. 

New York doctor using the prescription monitoring system on his computer

An audit of the New York State opioid prescription monitoring database found that patients in treatment for opioid dependency may have received potentially dangerous opioid prescriptions outside of their treatment programs.

Newly re-elected State Comptroller Thomas P. DiNapoli issued a statement indicating that some treatment programs were not cross-referencing patients' treatment with other opioid prescriptions, or coordinating with health care professionals.

The audit showed that a third of Medicaid recipients in treatment received opioid prescriptions outside of their program; of that number, nearly 500 were said to need medical treatment for an opioid or narcotic overdose within a month of receiving the prescription, and 12 died as a result of said overdose.

The Internet System for Tracking Over-Prescribing (I-STOP) is a database of records for all controlled substances dispensed in the state and reported by either a pharmacy or dispenser. Treatment programs are not required to disclose the medication they give to patients, but in some cases, are required to check I-STOP to determine if a patient is receiving opioid prescriptions from other sources.

If outside prescriptions are found, the program can consult with health care professionals to determine the appropriate response, after consent from the patient is obtained.

According to the statement, DiNapoli's auditors looked at state Department of Health (DOH) records from October 1, 2013 to September 30, 2017 and found 18,786 Medicaid patients who were receiving opioid treatment—usually methadone—through a recovery program as well as additional opioid prescriptions. Of that group, 493 required medical attention as a result of 691 opioid or narcotic overdoses that occurred within a month of receiving the opioid, and 12 died while under medical care.

The statement also reviewed medical records from a sample group of 25 Medicaid recipients from three treatment programs. Data from Medicaid showed that these individuals had received 1,065 Medicaid opioid prescriptions while undergoing treatment; additionally, these treatment programs only cross-referenced the patients' data on 18 occasions, and did not check if a medication-assisted opioid was prescribed for take-home use, which is required by state law.

Consent forms to coordinate care with prescribers were required of only 13 of the 25 in the sample group, of which three did not sign the form. The programs were aware of only 53% of those Medicaid prescriptions for these patients, while consent to care was coordinated for just 8% of those prescriptions. 

"New York and the rest of the country are facing an opioid addiction epidemic, and people's lives are at stake," said DiNapoli in the statement. "Programs designed to get individuals off highly addicted opioids can only be effective with proper vigilance. The state Department of Health should take steps to help treatment programs and health care providers work together to prevent overdoses that could lead to hospitalizations or death." 

DiNapoli's statement also included a list of recommendations for the DOH to improve I-STOP, including a report that notifies treatment programs when recipients are receiving opioid prescriptions. The DOH did not agree with all of the audit's conclusions, but added that actions would be taken to address the suggestions.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.