Policy Analysis: New York State I-Stop Program

The New York state Internet System for Tracking Over-Prescribing (I-STOP) is a law which was established to save people’s lives by reducing prescription diversion and abuse. The law requires that all prescribers within the state to transit to the program in all pharmacies for the benefit of all citizens. Prescribers are mandated to review the history of a patient’s prescription contained in an online system prior to providing prescription of a controlled substance and report on any prescription they may write (Nutt. et al, 2016) The program is important as it helps New York to collect data on controlled substances and therefore preventing adverse effects of drugs such as opioid overdoses, diversion, and abuse through minimizing the amount prescribed or the frequency.

Internet System for Tracking Over-Prescribing has been chosen as a topic since it’s a trending program adopted by most healthcare workers in the United States with the aim of assisting physicians, prescribers, pharmacists, and law enforcement agencies to allow for the legitimate medical use of substances and effectively limit their abuse. The dispensers of controlled substances have to register with the program and report on any dispensation made on a patient through an electronic online database. I-STOP is a controversial topic since it has been applied in more than forty states but only a little information is known but citizens of the program and its overall effectiveness (Nutt. et al, 2016)

Included in article 33 of the Public Health Law in New York, Internet System for Tracking Over-Prescribing regulates manufactures, prescribers, and distributors of controlled substances within the state of New York. It is also available in Part 80 of Title 10 within New York Codes and became effective in August 2013.

The policy was developed to facilitate people dealing with medical drugs such as pharmacists and physicians to electronically transmit prescription data from healthcare providers to the pharmacy ensuring that the information is accurate and understandable. Internet System for Tracking Over-Prescribing was developed as a mechanism to reduce and prevent problems that arose previously from traditional prescription scripts. It shares substantial information that connects a patient and a healthcare provider thus allowing for relevant decision making when prescribing controlled substances (MedRunner, 2011)

Several drugs have been listed by the program; notably, marijuana, etorphine, heroine, and ibogaine led to the creation of controlled substance programs as they were mostly abused. The drugs became an issue in New York where most violence cases were reported to be associated with people under the influence of the substances. People taking these drugs became less productive and overdose cases led to deaths of citizens every year (Nutt. et al, 2016). Moreover, inappropriate prescription of opioid drugs has led to some children becoming orphans where parents are victims of deaths associated with overdoses of the drugs.

Between 1999 and 2010, opioid prescriptions have increased dramatically in New York by over 300%. This has led to diseases and deaths of people from 1000 to 4000 over the years. In New York State, the overdose of these substances has been listed as one of the major causes of accidental deaths with thousands of citizens being considered as opioid abusers. In the United States, prescription painkillers have killed more than 15000 people in 2008. From 2007 to 2010, the prescription for narcotics in New York rose from 16 million to 22 million. Teenagers and the youths have been the large part of citizens affected by drug abuse and addiction. Notably, people between the age of 18 and 35 are reported as victims of drug overdoses (MedRunner, 2011)

The problem arises due to the limited training of physicians and unintentional prescription where patients receive higher dosages than required. There has been a lack of checks and balance when physicians utilize only the report provided by a patient. Moreover, having limited interactions with patients leads to making bad decisions when administering controlled substances prescriptions. Generally, the society has lost its productivity, morals, and lives as a result of addiction, diseases, and deaths from opioid drugs (Nutt. et al, 2016).

The known and potential causes of deaths can be associated with the availability of opioid drugs without a prescription. Some patients and addicts gain access to the drugs without prescriptions. Some physicians sell these substances even without prescription. Another cause of the problem is lack of enough knowledge by people administering the drugs. It results in wrong prescriptions and overdoses where a patient receives more of the controlled substances than required (MedRunner, 2011). Lack of controlled patient previous records leads to inappropriate prescribing. The application of Internet System for Tracking Over-Prescribing within New York facilitates for better and accurate medication and therefore reducing the adverse effects that are associated with drug abuse.

Policies have been developed in the past to control prescriptions by physicians. The Health Information Technology for Economic and Clinical Health Act (HITECH) of the United States was developed in 2009 to provide for e-prescribing as a method of managing electronic medical records. The national council tasked with prescription drug programs is responsible for developing standards for transmission and determining prescriptions. Many healthcare facilities in New York have adopted the I-STOP policy; in particular, New York has increased e-prescribing from 23 percent to 68 percent.

The selected policy aims at controlling the misuse and abuse of controlled substances through managing care payers. Initiated by the New York state legislation, the Internet System for Tracking Over-Prescribing (I-STOP) Act created a real-time online platform that enables tracking and reporting information on controlled substances to both pharmacists and practitioners. New York citizens largely benefit from this policy. It takes an aggressive approach to control prescription drugs from abuse by individuals. On 2011, a 21-year-old Israelite citizen committed suicide when he was unable to control his addiction to prescription drugs (Rufus, 2015). The program decreases prescribing errors and avoids adverse drug reactions. Moreover, it improves medical compliance and reduces cases of drug abuse through informing pharmacists on a patient history in relation to controlled substances (Okun, 2010).

All New York citizens are eligible for the Internet System for Tracking Over-Prescribing (I-STOP) program. Dispensers of drugs in the program are required to register for free. The policy is implemented through ensuring records of all citizens with reference to controlled substances are recorded in an online database. Practitioners are therefore able to access the data and dispense appropriate prescriptions. The policy is funded by the federal government and any other institutions promoting the welfare of New York citizens (Schneiderman, 2012). The criterion for determining the effectiveness of the policy has not been established as little information is available about the program. However, as the program continues to grow, its effectiveness will be determined by the reduction in the number of controlled substance deaths and abusers.

The I-STOP policy will take time to be perfectly implemented. The program will mandate all practitioners to access the history of a patient on an electronic system before giving out prescriptions. Significantly, it would be accessible and easier for prescribers to consult the registry containing patient’s information and therefore dispensing controlled substances knowledgeable.

The goal of the New York State I-Stop Program was to facilitate pharmacists and doctors in providing controlled substances and other prescription pain medications to patients in need. I-STOP also aimed at alarming these professionals with valuable data used to detect harmful drug interactions. Additionally, identification of abuse patterns by patients, pharmacists and doctors could be detected. Another goal was to help to help patients with crippling addiction and be in a position to help them before the condition starts and worsens (Schneiderman, 2012). Among the outcomes achieved, the program was able to establish New York as the first state to effectively control physicians and ensure that they have a database which was used to consult a patient’s prescription history prior to administration of any substance. Moreover, the program made New York the second and biggest state that required the filling and scheduling of prescriptions by pharmacists.

New York also became the number one state to bring about the concept of e-prescription in controlling substances abuse by patients. Automatic refilling of hydrocodone drug was highly abused through rescheduling of the drug to schedule II (Okun, 2010) Tramadol, a dug that was previously unscheduled was scheduled under schedule IV substances and this made it impossible to acquire on the streets. I-STOP also established a program that facilitated the safe disposal for providing New York residents with a platform through which they could eliminate expired and drugs not required.

Prescription drug monitoring helped physicians in detecting doctors involved in illegal shopping and this helped in serving patients with addiction problems (Rufus, 2015). Doctors also had a chance to use the information to prevent harmful drug interactions. E-prescription eliminated the forging or stealing of prescriptions which was commonly practiced by patients, criminal organizations, and addicts who used this niche to obtain the pills and later resell on the streets (Rufus, 2015). Furthermore, there was improved prescriber convenience through the use of mobile devices which had the capability of working on a wireless network to renew and write prescriptions. Additionally, Pharmacists and prescribers had the impact of saving resources and time spent on faxing prescriptions. This was attained by reducing handling costs, labor costs and unreliable expense waste on papers (Rufus, 2015)

Despite the positive outcomes, the program had a number of limitations and negative outcomes. First, there was huge costs pertaining the purchase implementation and running of the program. This made it difficult for small clinical health workers to effectively incorporate the program. It was also hard to change the management system from paper prescription to e-prescription (Okun, 2010). Most health care providers and staff had a current management system and changing it was difficult as it required training and creation of awareness on the new system. Choosing the appropriate software applications and hardware platform posed a challenge to small and busy clinics. The reason behind this challenge is because most of them have limited information access making it hard to incorporate and maintain the new system (Okun, 2010)

In Conclusion, New York currently faces an epidemic of prescription drug abuse. According to a June 2012 press release by Schneiderman, Americans who constitute 4 percent of the global population consume 99 percent of hydrocodone and 80 percent of opioids supply. The policy can be made better by ensuring it is cheap and easy to use all over the world and not only in New York. Despite the negative outcomes, New York I-STOP program has proved to be effective in controlling the dispensing and prescription of drugs (Schneiderman, 2012). The recommendation is that the world and other states should adopt this program in various health practices as it has proved to be relevant and of importance in New York.

References

MedRunner Inc. (2011). E-Prescribing. Retrieved November 22, 2011, from MedRunner Inc.: http://www.medrunner.ca/learn-more/eprescribing/

Nutt, David J.; King, Leslie A.; Phillips, Lawrence D (2016), Independent Scientific Committee on Drugs. “Drug harms in the UK: A multicriteria decision analysis”. The Lancet. 376 (9752): 1558–1565. Doi: 10.1016/S0140-6736(10)61462-6.

Okun, M. S.; Boothy, L. A.; Bartfield, R. B.; Doering, P. L. (2010). “GHB: An important pharmacologic and clinical update”. Journal of Pharmacy and Pharmacological Science. 4(=2): 167–175.

Rufus (2015) “The 1970 Act: Don’t Sit There, Amend Something”. The Drug Hang Up, America’s Fifty-Year Folly. Schaffer Library of Drug Policy.

Schneiderman, (2012) A.G. Schneiderman’s Landmark I-STOP Bill To Curb Rx Drug Abuse Unanimously Passes NYS Legislature

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