The I-Stop legislation which was unanimously passed by the state Legislature last year and will go into effect on Aug. 27, had laudable intent — to curb widespread abuse of narcotics and other potentially additive medications. However, the legislation risks a number of unintended consequences to the detriment of patients and to medical professionalism.
I-Stop requires physicians to investigate, using a statewide pharmacy data base, the prescription use of virtually every outpatient before prescribing for them particular medications for pain, anxiety, and attentional disorders.
Under the I-STOP law physicians must presume that every patient is guilty of medication abuse until cleared by the data-base. Never mind that patients can circumvent the data base by filling prescriptions in the neighboring states of New Jersey, Connecticut, Massachusetts, Pennsylvania, and Vermont.
I-Stop changes the paradigm of the patient-doctor relationship which, up until now, was based on good faith. Doctors presume that our patients are trustworthy — we don't independently verify information that they provide unless there is concern of inaccuracy.
In fact, there is no precedent in New York law for compelling physicians to prospect for information about their patients when not indicated by clinical judgment. If public welfare is a main concern, far greater patients die each year from complications of warfarin, a potent blood thinner, than from pain medications, yet no legislator has advocated for a required review of a pharmacy database for concurrent use of medications that may exacerbate bleeding.
Also under consideration is legislation that would require all physicians to receive education in pain medications, including doctors who specialize in cancer, palliative medicine and pain. The proposed legislation requires that all prescribing physicians undergo between two and eight hours of education, even though similar educational programs mandated by the state — infection control, for example — has had little impact on patient outcomes.
Most importantly, I-Stop creates administrative barriers to good patient care and this comes at a cost to patients. A recent survey of physicians conducted by the Medical Society of the State of New York, found that half of New York physicians plan to stop prescribing these medications due to time constraints, administrative hassles and fears of increased liability risks or patient complaints, and instead plan to refer their patients to specialists.
Unfortunately, there is already a shortage of pain and palliative physicians in New York state, so patients are likely to suffer. Physicians, under the penalty of law, must check every patient's prescription history. Unfortunately, the law does not discriminate between drug-seekers who fake a back injury and patients with cancer pain or a sixth-grader with ADHD, thereby creating an indiscriminate administrative burden that ultimately affects all patients.
Many remedies to prescription drug abuse that are more effective and less impactful on deserving patients could be developed if the legislature chose to partner with doctors and the patients of New York. There is no doubt that prescription drug abuse is a significant and growing public health problem. Sadly for New Yorkers, I-Stop may do more to stop the treatment of pain than the abuse of pain medications.
Jeffrey T. Berger, M.D., is the chairman of the Bioethics Committee, Medical Society of the State of New York and a palliative medicine physician practicing in Westbury, Cayuga County.