While there is a lot on New York’s 2012 Legislative Agenda, there are few policies that affect us as EM physicians as much as the I-STOP Act. I-STOP stands for the Internet System for Tracking Over-Prescribing. It serves as a new act to create an on-line controlled substance reporting system, in which physicians will be required to report in real-time the prescription of controlled substances to patients. In addition, physicians and pharmacists would have to look up a patient’s prescription history before prescribing or dispensing any of these medications. If a provider fails to report or to investigate a patient’s history, they could potentially be fined.
As you can imagine, everyone has differing opinions on this topic. The supporters see it as a way to catch drug abusers earlier, so that they can properly be counseled before things get out of control. The opposition is concerned about patient privacy and the impact on both doctors and pharmacists. Our own New York ACEP has stated their position on this topic and has even made it an Action Alert on their website.
While I promised myself that I would not inject too much of my opinion into this blog, I can’t help but think of how this will impact the Emergency Department and our daily prescribing habits. Think about how many times a shift that you write for Percocet or Tylenol #3 for pain control at home. Now think about how much time it’s going to take to not only go through this patient’s prescribing history prior to writing said prescription and then proceeding to log in the new prescription. Let’s say the patient has a long history of prescription drug abuse, but has presented to the ED for a newly fractured leg – are you going to be less likely to prescribe the pain medication? Is it going to make you think twice before doing so?
All of that being said, there will be exceptions to this prescribing rule for emergency prescribers – oral 5 day prescriptions and those filled by institutional pharmacies are two of the exceptions.
What do you guys think? Should we be for or against this legislation? If you could amend this legislation, what exceptions would you include?
For more information on I-STOP:
For more information Regarding New York ACEP’s position on I-STOP:
New York ACEP Memorandum Regarding I-STOP
cbradby
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3 Comments
doty · April 29, 2012 at 11:33 am
I think this is a great idea in principle. However, I think the data should be obtained from the pharmacies. Most of this data is already collected at the pharmacy. There could be a weekly data dump to collect the data then the state would have a database we could query on demand or even automatically now that most people have gone to electronic prescriptions.
Mandating the use of electronic prescriptions would make this data easy to collect.
jwillis · May 18, 2012 at 5:17 pm
I think it would be a great resource. I don’t like the idea of putting this responsibility on physicians though and would hope it wouldn’t prevent adequate pain control. I think there are plenty of times we are all suspicious and wondering how many perc prescriptions some of our patients have. So we would at least be able to confirm or debunk our suspicions during a shift.
I like Dr. Doty’s idea of placing this on the pharmacists, it should be easy enough to regulate at their level.
mritchie · May 18, 2012 at 6:13 pm
I would agree with Dr. Willis and Dr. Doty. I think that having the physicians due this step would not be the correct choice. I think this would cause some physicians to not prescribe opioids on patients that need it because they would not want to go through the hassle. There is already a concern for people’s pain being undertreated and I think this would worsen this.