OxyContin scripts skyrocket among Medicaid users

PRESCRIPTIONS for OxyContin - a potent drug for chronic pain often cited as a gateway to heroin abuse - are skyrocketing in both Nassau and Suffolk's Medicaid systems, fueling concern among officials that the highly addictive pills are getting into the wrong hands.

The number of Medicaid-backed prescriptions for OxyContin in Nassau rose from 382 in 2007 to 1,369 last year - an increase of 258 percent. In Suffolk, the increase for the same period was 227 percent. Prescriptions in Nassau for the strongest OxyContin, the so-called "Oxy 80," have risen 800 percent, according to county officials. And the numbers for 2010 are on pace to dramatically outstrip last year's, officials said.

Health experts say controlling the supply of pain pills is critical as Long Island remains in the grip of a heroin epidemic. In many cases, experts say, young heroin users start their opiate abuse with the illicit drug's legal counterpart - pain medications such as OxyContin, oxycodone, Vicodin, and Percocet - usually gathered from home medicine cabinets. Some resort to grinding pills to snort, inject or even smoke, maximizing the euphoric jolt - and the risk of overdose or death.

"The specialty of pain management has exploded in the last four or five years, and it's very acceptable now and considered the standard of care to give narcotics to the people who need them," Dr. Richard Blum, chairman of the pharmacy and therapeutics at St. Francis Hospital in Roslyn.

But local and state officials say they want to learn how much of the increase can be attributed to legitimate pain relief for growing Medicaid rolls, and how much can be attributed to cases of suspected doctor shopping, phony prescriptions or other fraud.

"We're seeing an obvious financial concern, but there is a public health component, too, and we're worried about the fraud component as well," said Scott Skrynecki, director of Nassau's Medicaid fraud investigation unit.

If OxyContin prescription rates in Long Island Medicaid rolls stay on pace this year, there will be a 33 percent increase over last year. Among several responses in recent months, Suffolk officials are poised to undertake a first-ever effort: an audit of the county's approximately 2,300 Medicaid-backed OxyContin prescriptions paid so far this year, linking each to a patient, doctor and pharmacist to look for irregularities.

"This might be a rare opportunity to prevent addiction from happening by diverting the abuse of Medicaid," said Gregory Blass, Suffolk's commissioner of social services. "The goal is to detect multiple prescriptions obtained through Medicaid that are in excess of what would be acceptable, and when we find those red flags, we will pursue them."

In 2008, the state paid just over $1 million for Oxy 80 prescriptions for Medicaid recipients on Long Island, according to statistics of the state Office of the Medicaid inspector general. That amount compares with $2.44 million so far this year.

Nassau's social services commissioner, John Imhof, has twice raised concerns with the county medical society in recent months, in letters, over the increases in prescriptions for the narcotic. Medical society executive director Mark Cappola said a letter was published in its newsletter, and that the group plans to host a pain medication education program early next year.

At the state level, a Medicaid fraud investigator, calling the Long Island numbers "a real concern," said last week that the agency would dedicate more people to fraud investigations on Long Island related to OxyContin.

After inquiries from Newsday, Suffolk County Police Department officials said they would formalize and increase referrals to county and state investigators of cases of suspected doctor shopping, phony prescriptions, or other fraud.

After arriving on pharmacy shelves in 1996, OxyContin quickly became the country's bestselling narcotic pain medication. Its primary benefit, doctors say, is the pill's time-release coating, which allows patients with serious pain to take just one or two a day.

"I have many patients, business people, construction workers, who have serious pain and are able to go about their normal lives because of OxyContin," said Blum, an advocate for the responsible use of pain medications.

Dr. Steven Kipnis, medical director of the state Office of Alcoholism and Substance Abuse Services, agrees that OxyContin can be an effective and safe medication for people who are not predisposed to abuse it. But among addicts, "it has a reputation far better than it will ever deliver, and that's part of why people start hunting around for the better high," he said.

On the black market, "Oxy 80s are top of the line, the most sought after," said Det. Lt. William Burke of the Suffolk police Narcotics Squad, selling for as much as $50 for a single pill. "That's why the kids go from there to heroin, because they can get heroin for $10 a bag."

In April, the federal Food and Drug Administration approved a new OxyContin pill that turns into a gummy substance when ground. The drug's maker, Purdue Pharma LP, says while no evidence exists that the change will stop abuse, the new pill was made to be "more difficult to manipulate for the purpose of intentional misuse and abuse." The new pills began reaching pharmacists in August.

"Purdue Pharma is working . . . to help curb the abuse of prescription medications, while making sure they remain available for the legitimate patients who need them," Purdue spokesman James Heins said in a written statement.

Michael Little, state deputy Medicaid inspector general for investigations and enforcement, said it was impossible to know how much fraud is contributing to the dramatic increases.

"I'm confident . . . [OxyContin prescriptions] are going up in larger metropolitan areas, but Nassau, in particular, the numbers jump out at you," he said. "I don't know why, but I can tell you from our contact with other enforcement agencies, they have all noticed it.

After a recent review of local statistics, Little said his office planned to dedicate more personnel to Long Island fraud investigations. As to the cause of the increase: "No one has really come up with the definitive reason as to why."
Problem with prescription drugs?

Here's where to go for help:

The Partnership at Drugfree.org (for information about prevention, intervention, and recovery) www.drugfree.org

New York State HOPEline

1-877-8-HOPENY

Long Island Council on

Alcoholism and Drug Dependence (evaluates problems,

arranges interventions and

refers to services)

516-747-2606

Long Island Crisis Center

(counseling and referral hotline for addicts and their families)

516-679-1111

Narcotics Anonymous

Nassau: 516-827-9500

Suffolk: 631-689-6262

Response to the rise in Medicaid prescriptions for OxyContin

Planned audit in Suffolk County of

all Medicaid-backed OxyContin

prescriptions

More investigators from the state Office of the Medicaid inspector general to be assigned to Long Island cases

Suffolk police have formalized and increased referrals to investigators of suspected Medicaid or prescription fraud

Warning letters about a spike in

OxyContin prescriptions to the

Nassau County Medical Society