Statement by Robert Hughes, Md, President, MSSNY, Regarding Proposed Prescription Drug Registry

WESTBURY, NY (06/04/2012)(readMedia)-- Physicians agree that the abuse and diversion of pain medications is a serious public health threat and must be addressed. MSSNY has worked closely with the Department of Health, which operates the existing prescription drug monitoring program, to improve accessibility to the database and to make the information contained in it more reliable. We believe that the DOH is on track to assure these changes are made. In a more perfect world, that should be the end of the story.

This issue, however, has become highly political. What is being discussed is a requirement for physicians and other prescribers to consult the database each and every time they write a prescription for a controlled substance to make sure that the patient before them isn't doctor shopping for drugs. All patients. All controlled substances.

What purpose does it serve to require:

• a busy pediatrician's practice to consult the database for all children who come in for their monthly prescription for ADHD medication;

• an oncology practice to consult the database for each cancer patient in need of pain relief;

• a psychiatrist to consult the database each time she is going to write a prescription for Valium or Xanax for a person with anxiety disorder;

• a primary care physician to check the database before prescribing Lyrica ® for a patient he has treated for twenty years who suffers from post neuralgic pain related to diabetes;

• a surgeon to consult the database before he prescribes post-operative pain medicine?

Proponents of this concept suggest that a physician or the member of their staff to whom they delegate this responsibility should consult the database on all the patients they expect to see at the beginning of the day – a process that ignores the fact that many of the patients will not be prescribed controlled substances and that patients may be added to the schedule during the day. Furthermore, they do not realize that the physician's electronic health record system cannot seamlessly connect to the database. It takes between 4-8 minutes to click out of the EHR, log onto the database, download the information, and then get back into the electronic health record. For busy primary care practices where one physician will see approximately 30 patients, that's 2-4 hours a day per physician in the practice. A five-physician practice with two nurse practitioners would need to devote 14-27 hours of staff time each day to this task. The Medical Society is very concerned that an across-the-board a duty to consult the database in all instances is so onerous that physicians and other prescribers will modify their prescribing practices, causing real access problems for patients. Many patient advocates agree.

Last month, MSSNY conducted a survey concerning the impact of proposed legislation requiring physicians to consult a state prescription monitoring database before prescribing a controlled substance. 70% of the responders indicated that they would limit their prescribing of controlled substances to specific patients or would refer patients to pain management specialists. Due to concerns about abuse and diversion of prescription medications, patients with legitimate pain needs already are finding it challenging to get their needs addressed.

We believe strongly that the remedy for this problem must not be so draconian as to result in prescribers radically changing their prescribing practices. This would create difficulty for those patients in need of controlled substance medication.

The primary focus of the media has been on what has been characterized as the over-prescribing of opiates such as hydrocodone or oxycontin. If that is where the problem lies, then that is where the focus of legislative action should be.

We must recognize that substance abuse is a societal problem and that a multifaceted solution is needed. We have proposed several steps to address the societal problem of prescription medication abuse and diversion. We invite the editorial board to publish our recommendations which can also be found at www.mssny.org. We must strike an appropriate balance between addressing the growing problem of abuse while also assuring that patients can continue to obtain needed medication.

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Medical Society of the State of New York

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Albany, NY 12210