Hamlin: Reformat NYS painkiller database

Dr. Paul A. Hamlin, a pulmonologist practicing in Lake Success, is president of the Medical Society of the State of New York.

A New England Journal of Medicine article released last week concluded that persistent pain is an overlooked medical problem that affects more than 100 million Americans. Yet legislation being considered in Albany would potentially reduce the ability of patients to obtain medications to treat their pain.

The legislation would create the Internet System for Tracking Over-Prescribing database, or I-STOP, to monitor controlled-substance prescriptions. Physicians and other prescribers would be required to report every prescription they write for a controlled substance to the database. They would also be required to check the database before writing the prescription. Pharmacists would be prohibited from filling these prescriptions unless they've been entered in the database. Serious financial penalties would be imposed for failure to comply.

Doctors on Long Island and across New York State agree with the goal of this legislation -- to increase information available to physicians to assure that patients are not "doctor shopping" for pain medications. Indeed, there is already a database in New York State that can be reformatted to do exactly that.

But the I-STOP bill goes too far. Requiring physicians to both report prescribing data to a database and check it every time a controlled substance is written is unrealistic. Medical offices are already overwhelmed with administrative burdens imposed by health insurance companies, Medicare and Medicaid. This requirement could cause delays for patients waiting to see their doctors, or delays at pharmacies in obtaining needed medications.

Let's be very clear. Addiction to painkillers is a serious and growing problem. But it must be attacked on several fronts. There must be increased law enforcement to prevent and punish those who illegally deal and distribute prescription medications, including prescribers. There must be increased accessibility to treatment for patients suffering from addiction. There must be additional resources to educate doctors about the existing database and the circumstances that should trigger a prescriber to check it.

Most important, the current database must be made more readily available, and pharmacists should be given access to it.

New York State has maintained the current database of controlled-substance prescriptions for many years. In 2010, for the first time, prescribers were permitted to access data to check if patients have been doctor shopping. But the information available to doctors from the database is limited and difficult to access.

First, a physician must obtain and maintain a Health Commerce Account, a process many physicians have found cumbersome. Second, the website is hard to navigate. Third, physicians cannot delegate staff members to check the website. Fourth, the information available is limited to a short time frame, and no data at all are available unless a patient has reached a certain threshold of recent prescriptions written by multiple doctors and filled at multiple pharmacies.

Physicians are working with the State Department of Health to address these problems, since we believe making the data more thorough and readily available will result in great strides in the painkiller problem.

On the other hand, mandates proposed in the I-STOP legislation would cause serious unintended consequences in treating persons with addictions and in pain -- from cancer or terminal illnesses, for example -- and would surely limit access to needed treatment. Many physicians would simply refrain from prescribing crucial pain medications because the process would be too time consuming and they would fear the potential penalties.

New York must balance its responsibility to fight the abuse and illegal use of painkillers, while assuring that the state doesn't create obstacles that unintentionally interfere with patients' ability to obtain the medications they need.