Bureau of Narcotic Enforcement Update. Recent Changes to New York State s Controlled Substance Act

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1 Bureau of Narcotic Enforcement Update Recent Changes to New York State s Controlled Substance Act

2 Number of of drug-induced deaths deaths compared compared with other with types of deaths, US, other types of deaths, US,

3 Motor Vehicle Traffic, Poisoning, and Drug Poisoning (Overdose) Death Rates United States, Motor Vehicle Traffic Poisoning Drug Poisoning (Overdose) 25 Deaths per 100,000 population Year NCHS Data Brief, December, Updated with 2009 and 2010 mortality data. 3

4 Overdose deaths of all intents by major drug type, U.S., Number of deaths 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Opioid analgesic Cocaine Heroin Source: National Vital Statistics System 4

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7 Drug Overdose Deaths In 2010 there were 38,329 drug overdose deaths in the U.S % (22,134) involved pharmaceuticals; Opioids-75.2 % (16,651), Benzodiazepines % (6,497), Anitdepressants -17.6% (3,889), and Antiepileptic and antiparkinsonism - 7.8% (1,717) Source: Pharmaceutical Overdose Deaths, United States 2010; Jones, Mack & Paulozzi; JAMA 2013;309(7):

8 Prescription Monitoring Program All controlled substance medications dispensed by pharmacies and practitioners must be reported to the New York State Department of Health Bureau of Narcotic Enforcement Public Health Law 3331 and 3333 Over 23,487,152 records were submitted to BNE in 2012

9 DOH Use of PMP Data BNE Investigations Matched with lost/stolen prescriptions; provided to Medicaid & available online. Office of the Professions and Office of Professional Medical Conduct Education and Outreach by BNE and others Analysis for trends, cluster detection

10 New York State Prescription Drug Monitoring Program Monthly oxycodone scripts Rate is number of prescriptions filled per 1000 residents Monthly average percent change is based on best fitting Joinpoint trend Rate All scripts +1.77% per month /01/08 07/01/08 01/01/09 07/01/09 01/01/10 07/01/10 01/01/11 07/01/11

11 New York State Prescription Drug Monitoring Program Monthly oxycodone scripts By Patient Gender Rate is number of prescriptions filled per 1000 residents Monthly average percent change is based on best fitting Joinpoint trend Rate Male +1.71% per month Female +1.35% per month 01/01/08 07/01/08 01/01/09 07/01/09 01/01/10 07/01/10 01/01/11 07/01/11

12 New York State Prescription Drug Monitoring Program Monthly oxycodone scripts By Patient's Region of Residence Rate is number of prescriptions filled per 1000 residents Monthly average percent change is based on best fitting Joinpoint trend Rate Upstate NYC +1.57% per month +2.05% per month 01/01/08 07/01/08 01/01/09 07/01/09 01/01/10 07/01/10 01/01/11 07/01/11

13 New York State Prescription Drug Monitoring Program Monthly oxycodone scripts By Patient Age Rate is number of prescriptions filled per 1000 residents Monthly average percent change is based on best fitting Joinpoint trend Rate years +1.16% per month years +2.13% per month years +1.59% per month 60+ years +1.26% per month /01/08 07/01/08 01/01/09 07/01/09 01/01/10 07/01/10 01/01/11 07/01/11

14 Albany Allegany Bronx Broome Cattaraugus Cayuga Chautauqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex Franklin Fulton Genesee Greene Hamilton Herkimer Jefferson Kings Lewis Livingston Madison Monroe Montgomery Nassau New York Niagara Oneida Onondaga Ontario Orange Orleans Oswego Otsego Putnam Queens Rensselaer Richmond Rockland Saratoga Schenectady Schoharie Schuyler Seneca St Lawrence Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates Oxycodone Prescriptions per County, NYS, Rate per 1000 Chautauqua Niagara Erie Cattaraugus Orleans Allegany Monroe Wayne Oswego Jefferson Lewis Oneida Genesee Onondaga Cayuga Madison Livingston Ontario Seneca Wyoming Yates Cortland Tompkins Chenango Schuyler Steuben Tioga Broome Chemung St Lawrence Herkimer Montgomery Schenectady Rensselaer Otsego Schoharie Albany Delaware Sullivan Hamilton Franklin Fulton Age Adjusted Rate per 1000 residents Clinton Essex Greene Columbia Ulster Orange Dutchess Putnam Bronx New York Kings Nassau Queens Richmond Warren Saratoga Washington Rockland Westchester Suffolk

15 Oxycodone Presciptions by County Code, New York State, 2010 County Rate Circles are Spatial Scan Statistic (SaTScan) non overlapping clusters O Relative risk 2.5 or higher O Relative risk 2 or higher

16 Hydrocodone Prescriptions per County, NYS, 2010 Albany Allegany Bronx Broome Cattaraugus Cayuga Chautauqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex Franklin Fulton Genesee Greene Hamilton Herkimer Jefferson Kings Lewis Livingston Madison Monroe Montgomery Nassau New York Niagara Oneida Onondaga Ontario Orange Orleans Oswego Otsego Putnam Queens Rensselaer Richmond Rockland Saratoga Schenectady Schoharie Schuyler Seneca St Lawrence Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates Chautauqua Niagara Erie Cattaraugus Orleans Allegany Monroe Wayne Oswego Jefferson Lewis Oneida Genesee Onondaga Cayuga Madison Livingston Ontario Seneca Wyoming Yates Cortland Tompkins Chenango Schuyler Steuben Tioga Broome Chemung St Lawrence Herkimer Montgomery Schenectady Rensselaer Otsego Schoharie Albany Delaware Sullivan Hamilton Franklin Fulton Age Adjusted Rate per 1000 residents Clinton Essex Greene Columbia Ulster Orange Dutchess Putnam Bronx New York Kings Nassau Queens Richmond Warren Saratoga Washington Rockland Westchester Suffolk Rate per 1000

17 Hydrocodone Presciptions by County Code, New York State, 2010 County Rate Circles are Spatial Scan Statistic (SaTScan) non overlapping clusters O Relative risk 2.5 or higher O Relative risk 2 or higher

18 Prescription Drug Reform law Part A: I-STOP Part B: Electronic Prescribing Part C: Controlled Substance Schedule Changes Part D: 3309 Work Group Part E: Safe Disposal Program

19 I-STOP Internet System to Track Over-Prescribing

20 I-STOP Updates NY s PMP Requires more timely data Makes additional data available Increases information sharing

21 Duty to Consult Beginning on August 27, 2013, Practitioners must consult the registry in most cases prior to prescribing or dispensing any controlled substance listed in Schedule II, III, or IV

22 I-STOP Practitioners Practitioners must have a DOH Health Commerce System (HCS) Account. To obtain an HCS account, type the following url in browser s address bar: Click - apply for an HCS Medical Professions account. 22

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26 Exceptions Veterinarians Methadone programs Practitioner administering a CS For use within an institutional dispenser ED (limited to 5 day supply) Hospice Technological failure of PMP or practitioner s hardware

27 Exceptions Practitioner is unable to access in a timely manner (5 day supply) Consultation would adversely impact a patient s medical condition Practitioner has been granted a waiver by DOH based upon technological limitations or exceptional circumstances not within practitioners control

28 Additional Access to PMP Data Pharmacists AG s Medicaid Fraud Control Unit County Health Departments engaged in public health research or education Medical Examiner/Coroners Patients

29 Electronic Prescribing Public Health Law 281

30 Electronic Prescribing On March 27, 2013 DOH promulgated for electronic prescribing of controlled substances (EPCS) Electronic prescribing will be mandatory for all practitioners on March 27, 2015

31 EPCS - Practitioners Prescribing application must meet security standards set forth by the DEA for e-prescribing controlled substances Identity proofing and two-factor authentication to ensure prescription integrity and non-repudiation

32 EPCS Exceptions Technological or electrical failure Practitioners who received a waiver (economic hardship, technological limitations, other exceptional circumstance) Use of EPCS would impact the patient s medical condition (up to 5 day supply) Issued by a practitioner to be dispensed outside of New York State

33 Changes to Controlled Substance Schedules Public Health Law 3306

34 Changes to Controlled Hydrocodone Substance Schedules Effective February 23, 2013 All products containing hydrocodone, regardless of formulation are now placed on schedule II, eliminating the ability to prescribe refills. Tramadol Placed on schedule IV

35 Part D: Prescription Pain Medication Awareness Program

36 Workgroup Established pursuant to PHL 3309-a Comprised of Practitioners, pharmacists, consumer advocates, and law enforcement agencies Will help preserve to protect access by patients with a legitimate need for controlled substances Will help DOH educate practitioners, pharmacists, and the public about controlled substance medications

37 Workgroup Will issue recommendations for continuing education for practitioners and pharmacists on pain management issues Will help create a public awareness campaign Guidance with implementation of I-STOP

38 Part E: Safe Disposal Program

39 Opioid Analgesics: Sources for Nonmedical Users United States, % 20% Prescribed to someone else Prescribed to user 76% Other National Survey on Drug Use and Health. Summary of national findings,

40 Safe Disposal Consumers need a means to safely dispose of prescription medications including controlled substances Safe disposal sites established with local police departments

41 Medication Drop Boxes by County

42 Safe Disposal Medication Drop Boxes Located in Westchester County Village of Croton-on-Hudson Police Department 1 Van Wyck Street Croton-on Hudson, NY Yorktown Police Department* 2281 Crompond Road Yorktown Heights, NY

43 Bureau of Narcotic Enforcement Riverview Center 150 Broadway Albany, NY Phone: (518) or (866) Regional Offices: NYC: (212) Buffalo: (716) Syracuse: (315) Rochester: (585)