State Attorney General Eric T. Schneiderman opposes two bills critics say would weaken the landmark I-STOP law that makes it difficult to obtain multiple opioid prescriptions and makes it easier for authorities to investigate the misuse of the highly addictive painkillers.
Allowing doctors to issue prescriptions by phone to nursing home patients and to others under emergency situations without a follow-up notification to the state Health Department would create opportunities for further abuses of opioids at a time overdose deaths are increasing, according Schneiderman and his staff who are urging Gov. Andrew M. Cuomo to veto the bills.
The governor’s office Friday said it is still considering the legislation, which was approved by the State Legislature in June.
“Clearly now is not the time to scale back I-STOP. Yet, read together, the bills have the combined negative effects of removing millions of prescriptions from the electronic requirements of I-STOP and eliminating any obligation to make a meaningful record of good faith invocation of the existing law exceptions to E-prescribing,” a letter from Deputy State Attorney General Brian K. Mahanna stated.
Under I-STOP, doctors must file prescriptions for opioids on a real-time electronic website, where they and pharmacists can check to see if a patient has multiple opioid prescriptions. The practice of “doctor shopping” has dropped 90 percent since I-STOP began in 2013. Under emergency circumstances, doctors are already allowed to issue prescriptions without immediately notifying the state Health Department or the I-STOP site.
One of the bills proposed to permanently exempt doctors who work in nursing homes from electronic prescribing but critics say that would diminish efforts to hold physicians more accountable, according to Mahanna.
“Healthcare errors are a major concern in the nursing home field and our Medicaid Fraud Control Unit regularly receives reports of and investigates numerous incidents of such errors. Many such incidents result from ordinary errors or negligence, but are compounded and indeed may rise to criminal conduct when records are omitted, altered or destroyed,” Mahanna stated. “Electronic prescriptions are also shown to reduce error and drug diversion, which is a particular problem in nursing homes.”
Nursing home doctors currently can issue opioid prescriptions over the phone, but are required to report the prescription to I-STOP within 72 hours.
Many individuals who undergo surgery in hospitals wind up at nursing homes for rehabilitative services where pain medications are often part of their treatment, opponents of loosening I-STOP requirements explained in the need to continue the 72-hour requirement.
Mahanna pointed out that doctors who provide nursing home services are generally employed on a part-time basis and “these physicians should already be utilizing E-prescribing in their other practice settings.”
The second bill would permit doctors to make a notation in the patient’s records, if they issued a paper prescriptions when a patient is going out of state, for instance on vacation, or if an electronic prescription would have delayed the patient from receiving medication, or if a power outage or technological failure occurred. Under those circumstances, doctors currently are required to notify the state “as soon as practical.”
“This bill would create a gaping loophole in I-STOP’s universal E-prescribing requirements. It would allow physicians who are unwilling to invest in E-prescribing technology or simply believe that E-prescribing is per se ‘impractical’ to avoid compliance with I-STOP’s requirements. What’s more, bad faith or ill-informed prescribers could accept a doctor shopper’s false promise that the paper prescription would be filled out of state,” Mahanna stated.
The attorney general’s urging of Cuomo to veto the bills is long overdue, according to Avi Israel, who with dozens of other local residents who have lost loved ones to opioids pushed for the adoption of I-STOP.
“With death rates not going down, especially in Erie County, these proposed changes will allow unscrupulous characters to exploit the loopholes,” Israel said. “In the end, we’d have more people hooked on opiates and falling into that pool called addiction.”
The Erie County Health Department has reported at least 250 confirmed or suspected opioid deaths this year. Last year, there were 256 for the entire 12 months.
Israel, whose son Michael took his own life while in the throes of opioid addiction in 2011, said he, other families and several prominent doctors sent a letter to Cuomo’s office last month urging him to veto the bills.
“The bills remain under review,” said Richard Azzopardi, the governor’s spokesman.