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Prescription tracking due in wake of abuse

Physicians and pharmacists will be required to participate in a new prescription drug-tracking program under legislation coming together at the State Capitol.

State officials hope to announce legislative agreement on the program next week in conjunction with the first anniversary of a suicide by a prescription drug-addicted man from Buffalo.

Tentative deals have been reached on key elements of a new system aimed at reducing the growing problem of doctor-shopping by people addicted to prescription drug opiates. New York officials believe that the Internet-based program will permit doctors and pharmacists to track prescriptions logged just 30 minutes behind real time.

Some details still need to be resolved, including whether to broaden the initiative to cover all drugs on a federal narcotics list, according to several sources speaking on condition of anonymity because of the sensitivity of the late-stage talks. Among the drugs on that federal list are some lesser-addictive drugs, such as cough syrup with lower levels of codeine.

All sides agree that the program will feature a "real time" reporting system -- in which doctors and pharmacists will have up-to-date information to discover if a patient is trying to stock up on painkillers and other narcotics.

Whether the system can be timely to within 30 minutes of a prescription being filled will depend on the ability of government regulators to devise a system capable of quickly absorbing hundreds of thousands of prescriptions a day, sources say.

The current voluntary program is often weeks behind when an actual prescription is written.

Following a Buffalo News special report, "Rx for Danger," last year, media across the state have reported on high-profile deaths and murders attributed to prescription drug addictions.

The "Rx for Danger" series found that prescription opioids have become more popular among drug abusers than cocaine and that Western New York is a hot spot for some of the most abused opioid painkillers -- fentanyl, hydrocodone and oxycodone.

Addicts and dealers, the series found, often get the drugs from friends and family members, but also steal them from pharmacies or persuade doctors to write prescriptions for which the patients have no medical need. Several doctors, according to the series, are part of the illegal marketplace.

The series also documented prescription painkiller overdoses and deaths.

Negotiators say there is a push to reach a final agreement on the new regulations as early as next Monday -- the first anniversary of the suicide of Michael D. Israel, 20, of Buffalo, who killed himself last June 4 in the midst of a prescription drug addiction problem.

"We've been pushing this real hard, and it looks like we're going to get this done," said Avi Israel, a Buffalo resident lobbying for the measure in honor of his dead son, who was able to doctor-shop to obtain narcotics.

In the worst-case scenario, state officials say, they want a final deal by June 19, the first year anniversary of the murder of four people at a Long Island pharmacy by a man stealing thousands of hydrocodone pills.

"We're confident that this is going to pass this legislative session," said Jennifer L. Givner, a spokeswoman for Attorney General Eric T. Schneiderman, who proposed the plan more than a year ago.

But physicians worry the system being discussed will force doctors to spend more time typing on computers while performing government-mandated tasks -- leaving less time for direct patient care. They also say if a new system is enacted, others in a doctor's office -- besides just the direct care giver -- should be able to input drug data into the system.

Physicians warn that the hurdles and potential legal problems in the new system could prompt some doctors to not prescribe painkillers, even to patients who might legitimately need them.

"We recognize there's a problem. We want to be part of the solution," said Dr. Robert J. Hughes, president of the Medical Society of the State of New York.

Lobbyists for physicians and some pharmaceutical interests have stepped up efforts to amend aspects of the tracking system. But industry officials say they acknowledge that the broader program will be approved before lawmakers end their 2012 session by the end of June.

Negotiators are still trying to nail down several outstanding issues, including whether all drugs on a federal government list should be covered by the real-time reporting initiative in New York.

Physicians argue that Schedule V drugs, which include a number of prescriptions that the federal government says have a lower risk level for abuse, should be exempt, according to people involved in the talks.

But those pushing to cover those drugs say they don't want to create a system with a list of exemptions.

Another concern: What to do about mistakes?

Suppose a name or address of a patient is spelled wrong by a doctor or is listed incorrectly in the database? And how does that patient get a needed painkiller to cope with a surgery's effects, especially if the mistake in the tracking system is discovered over a weekend or holiday?

Doctors now report prescriptions to a state Health Department database, but participation is voluntary, pharmacists are not part of the system, and reporting can be 45 days behind anything considered "real time."

Negotiators have also discussed "Big Brother" issues, such as whether the attorney general's Medicaid Fraud Bureau can have access to the prescription drug database.

But legislative officials say the final deal will end up maintaining existing protections, such as a court order, for investigators to get access to prescription drug records.

"The governor has been working with all stakeholders on a comprehensive package of prescription drug reforms, including modernizing the state's online prescription drug monitoring system, and is optimistic that the package will be agreed to and passed prior to the end of session," said Richard Bamberger, spokesman for Gov. Andrew M. Cuomo.

The real-time reporting legislation got a push last week with a report by a Suffolk County grand jury that examined the Long Island pharmacy shooting last year. The report essentially blamed the health care industry, including physicians, for not controlling an epidemic of prescription drug abuse.

That grand jury called on New York to require physicians to access a real-time reporting system. New York is one of only eight states that do not require at least weekly prescription reporting to physicians.

In Western New York, opiate painkillers are prescribed 70 percent more frequently than the state average.

Israel, the North Buffalo father whose son shot himself to death last year, said he plans to return to Albany soon for another round of lobbying -- this time focusing on Assembly Democrats.

"We need to speak to them as victims. They've got the picture from the point of view of doctors and pharmacists," Israel said. "They've not gotten it from the victims' point of view."