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State: Few doctors monitor drug database

A file photo of 80 mg pills of

A file photo of 80 mg pills of OxyContin. Credit: Newsday, 2010 / Thomas A. Ferrara

A fraction of New York's doctors monitor a state database that alerts them to patients who are abusing controlled substances or visiting multiple doctors for those prescriptions.

The state Health Department, which manages the database, said that through November just 2,216 of about 80,000 health care providers statewide who can prescribe painkillers and other drugs used the Controlled Substance Information system. It became available to doctors and other prescribers in spring 2010. Among those 80,000, a total of 47,000 have opened accounts with the online system.

"Do I use it as much as I thought I would? Not really," said Dr. Brian Durkin, director of the Center for Pain Management at Stony Brook University Medical Center, which has more than 4,000 patients. "It's not easy and quick to log on, and it's not exactly the information you want."

Some doctors said they don't need the system, which is voluntary, because they have controls in place to catch the patients who are drug abusers. Others said it is too cumbersome to navigate for physicians managing busy practices. Critics also say the database, which is updated monthly, is not current enough to be helpful.

In addition, the system does not allow doctors to check whether patients have gotten prescriptions for controlled substances filled in other states, and pharmacists don't have access to it.

The importance of tracking substance abusers and so-called doctor shoppers has been heightened since the disclosure that convicted killer David Laffer and Melissa Brady, his wife and accomplice, got hundreds of painkiller pills from physicians in the months leading up to June 19, when Laffer fatally shot four people in a Medford pharmacy and stole thousands of pills.

Newsday has reported that Laffer and Brady received almost 12,000 pills in the four years before the murders, often visiting many doctors and pharmacies in the same month. One drug they sought was the painkiller oxycodone, which last year contributed to more overdose deaths on Long Island than heroin.

Suffolk County District Attorney Thomas Spota said last month he would impanel a grand jury to investigate prescription practices and to examine New York's effectiveness in monitoring doctors.

The state continues to inform prescribers about how to use the system and is looking at ways to improve it, said Jeffrey Gordon, spokesman for the health department. The agency must balance the need to protect patient confidentiality with making the system user-friendly, he said.

In addition to the database, the health department sends letters to doctors warning them if a patient has been getting multiple prescriptions from other physicians. Doctor shoppers are defined as people who fill prescriptions from two or more physicians at two or more pharmacies in a month.

Gordon said chain pharmacies -- about two-thirds of those in the state -- update data weekly, although they, like all drugstores in New York, don't have access to it.

"The department encourages and expects practitioners to use the critical tools we are providing to them to both appropriately treat their patients and guard against those who are abusing medications," Gordon said.

Database shortcomings

New York's system is not a trendsetter. Most of the 37 states with similar programs are updated more frequently, usually every two weeks, said Sarah Kelsey, legislative attorney for the nonprofit National Alliance for Model State Drug Laws. Some states, such as Oklahoma, are beginning to institute systems that will make their data available in real time.

In that state, more up-to-date data have translated into more use, said Don Vogt of the Oklahoma Bureau of Narcotics. About 60 percent of Oklahoma's doctors use its system.

A majority of states also allow pharmacists access to their prescription monitoring programs. That is the goal of the federally funded Prescription Monitoring Program Center for Excellence at Brandeis University, said its director, John Eadie. "We are encouraging every state to provide data to pharmacists," he said.

The lack of current data is a reason Dr. Daniel Brietstein said he hasn't used New York's database. Brietstein, associate director of the division of integrative pain medicine at ProHEALTH in Lake Success, whose practice sees about 5,000 patients a year, said he has instituted safeguards to ensure that he will know if someone is a drug abuser.

LI docs' usage varies

Like many pain management specialists, Brietstein doesn't prescribe medication on the first visit, takes a detailed medical history, insists that the patient sign a contract stipulating he won't misuse the drugs and conducts random drug tests.

"We have so many things in place -- plus I have been doing this for 15 years," he said.

Dr. Frank Adipietro, director of anesthesiology and pain management at Eastern Long Island Hospital in Greenport, whose practice has 4,000 to 5,000 patients, said he doesn't use the database because, like Brietstein, he believes safeguards are in place. Adipietro said he will heed letters the state Health Department sends warning him if a patient appears to be doctor shopping. He also relies on the good relationship he has with pharmacists to alert him if someone appears to be filling multiple prescriptions.

"It works in a small community," he said.

Dr. Robert Duarte, director of the pain institute in Manhasset for the North Shore-Long Island Jewish Health System, whose practice includes more than 10,000 patient visits a year, said he uses the database to check on a new patient or if he is suspicious of a patient's behavior, such as someone who consistently runs out of medications too soon.

"The access is a little difficult," he said. "It is a little trying at times."

Dr. Daniel Laieta, an internist in Holbrook, said he found the system helpful and easy to use. But he wishes it were available to pharmacists.

"It's a less useful tool without that," he said.

Gordon, of the health department, said when the system went online the department did mass mailings to explain how it works and has contacted prescribers through dozens of presentations and newsletters.

Possible solutions

Many of the criticisms would be addressed in legislation that Attorney General Eric Schneiderman introduced last year and hopes to reintroduce this session, said spokeswoman Lauren Passalacqua. The new system, called I-Stop and run by the health department, would operate in real time and require both prescribers and pharmacists to check prescriptions for controlled substances online.

Craig Burridge, executive director of the Pharmacists Society of the State of New York, said a mandate requiring them to use the system would place a burden on pharmacists.

"We support having access, but don't want it mandated," he said. "You're talking about 74,000 controlled prescriptions a day -- that's about 10 percent of pharmacists' business."

State Sen. Kemp Hannon (R-Garden City), chairman of the Senate Health Committee, and Assemb. Michael Cusick (D-Staten Island) also introduced legislation last session to expand access to the system.

Dr. Thomas Jan, a pain management and addiction specialist in Massapequa, is among the minority of doctors who regularly log into the system. On a recent Monday, he was checking on seven new patients.

According to the database, between Oct. 4 and Nov. 25, one of the patients had seen three doctors who prescribed large quantities of the painkillers oxycodone and methadone and the anti-anxiety drug diazepam: 540 pills for the seven-week period.

Jan said he later confronted the patient about drug abuse and the individual "owned up to it." He offered the person outpatient drug rehabilitation treatment and a prescription for suboxone, a medication used to treat opioid addiction.

He acknowledges the system is not initially easy to access, but he has little patience with doctors who don't use it.

"If you don't have time to do it right, don't prescribe those drugs," he said.