Bureau of Narcotic Enforcement Update Recent Changes to New York State s Controlled Substance Act
Number of of drug-induced deaths deaths compared compared with other with types of deaths, US, 1999-2006 other types of deaths, US, 1999-2006
Motor Vehicle Traffic, Poisoning, and Drug Poisoning (Overdose) Death Rates United States, 1980 2010 Motor Vehicle Traffic Poisoning Drug Poisoning (Overdose) 25 Deaths per 100,000 population 20 15 10 5 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NCHS Data Brief, December, 2011. Updated with 2009 and 2010 mortality data. 3
Overdose deaths of all intents by major drug type, U.S., 1999-2009 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 99 00 01 02 03 04 05 06 07 08 09 Source: National Vital Statistics System 4
Drug Overdose Deaths In 2010 there were 38,329 drug overdose deaths in the U.S. 57.7 % (22,134) involved pharmaceuticals; Opioids-75.2 % (16,651), Benzodiazepines - 29.4% (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):657-659
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
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
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 15 14 All scripts +1.77% per month 13 12 11 10 9 8 7 01/01/08 07/01/08 01/01/09 07/01/09 01/01/10 07/01/10 01/01/11 07/01/11
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 16 15 14 13 12 11 10 9 8 7 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
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 17 16 15 14 13 12 11 10 9 8 7 6 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
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 30 20 0-19 years +1.16% per month 20-39 years +2.13% per month 40-59 years +1.59% per month 60+ years +1.26% per month 10 0 01/01/08 07/01/08 01/01/09 07/01/09 01/01/10 07/01/10 01/01/11 07/01/11
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, 2010 0 100 200 300 400 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 71-113 114-135 144-161 161-184 189-399 Clinton Essex Greene Columbia Ulster Orange Dutchess Putnam Bronx New York Kings Nassau Queens Richmond Warren Saratoga Washington Rockland Westchester Suffolk
Oxycodone Presciptions by County Code, New York State, 2010 County Rate 71-113 114-135 144-161 161-184 190-399 Circles are Spatial Scan Statistic (SaTScan) non overlapping clusters O Relative risk 2.5 or higher O Relative risk 2 or higher
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 80-260 265-318 319-370 374-421 433-624 Clinton Essex Greene Columbia Ulster Orange Dutchess Putnam Bronx New York Kings Nassau Queens Richmond Warren Saratoga Washington Rockland Westchester Suffolk 0 100 200 300 400 500 600 700 Rate per 1000
Hydrocodone Presciptions by County Code, New York State, 2010 County Rate 80-260 265-318 319-370 374-421 433-624 Circles are Spatial Scan Statistic (SaTScan) non overlapping clusters O Relative risk 2.5 or higher O Relative risk 2 or higher
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
I-STOP Internet System to Track Over-Prescribing
I-STOP Updates NY s PMP Requires more timely data Makes additional data available Increases information sharing
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
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: https://hcsteamwork1.health.state.ny.us/pub/top.html Click - apply for an HCS Medical Professions account. 22
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
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
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
Electronic Prescribing Public Health Law 281
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
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
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
Changes to Controlled Substance Schedules Public Health Law 3306
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
Part D: Prescription Pain Medication Awareness Program
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
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
Part E: Safe Disposal Program
Opioid Analgesics: Sources for Nonmedical Users United States, 2009 4% 20% Prescribed to someone else Prescribed to user 76% Other National Survey on Drug Use and Health. Summary of national findings, 2008-2009 http://www.oas.samhsa.gov
Safe Disposal Consumers need a means to safely dispose of prescription medications including controlled substances Safe disposal sites established with local police departments
Medication Drop Boxes by County
Safe Disposal Medication Drop Boxes Located in Westchester County Village of Croton-on-Hudson Police Department 1 Van Wyck Street Croton-on Hudson, NY 10520 Yorktown Police Department* 2281 Crompond Road Yorktown Heights, NY 10598-3735
Bureau of Narcotic Enforcement Riverview Center 150 Broadway Albany, NY 12204 Phone: (518) 402-0707 or (866)- 811-7957 www.nyhealth.gov/professionals/narcotic/ E-mail: narcotic@health.state.ny.us Regional Offices: NYC: (212) 417-4103 Buffalo: (716) 847-4532 Syracuse: (315) 477-8459 Rochester: (585) 423-8043