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New York’s I-STOP Law: Reducing Opioid Abuse via E-Prescriptions

posted on Mon, Apr 11 2016 4:59 pm by Matthew Saria and Kim Weidenaar

Roughly 46 Americans die each day from overdose on prescription painkillers like oxycodone, hydrocodone and methadone. In 2012, 259 million opioid prescriptions were issued, a rate that has steadily increased since the late 1990’s. The widespread availability of painkillers is alarming because many opioid prescriptions are issued for symptoms and conditions for which evidence is weak or nonexistent, and even legitimate pain-related opioid use can sometimes evolve into abuse and addiction. Some of those who become addicted to prescription opioids  move on to drugs such as heroin or fentanyl because they are easier to obtain, cheaper and more potent. Three out of four new heroin users admit to abusing prescription painkillers before ever trying heroin.

New York State has implemented a number of provisions aimed at limiting the potential for prescription drug abuse from theft, forgery, and over-prescription. The primary vehicle used to address opioid use was the 2012 Internet System for Tracking Over-Prescribing (I-STOP) law, which included a series of provisions implemented from 2013-2016. Sections of this law which have been implemented to date include establishment of a Prescription Monitoring Program (PMP), rescheduling of certain commonly abused drugs, creation of safe disposal sites for unused prescription drugs, and improved education and outreach regarding prescription drug abuse.

The final part of New York’s I-STOP law went into effect on March 27, 2016. This final segment mandates doctors to abandon their prescription pad in favor of a computer based E-Prescription process. Doctors must now transmit a prescription through a digital program that forwards it directly to the patient’s designated pharmacy. Doctors who are noncompliant with the mandate can face both fines and possible imprisonment.

Prior to this mandate, New York doctors were required to consult the PMP to avoid dangerous drug interactions, detect doctor shoppers,  and “better serve patients at risk of addiction” when prescribing Schedule II-IV substances. Nevertheless, the program’s weak link was the potential for physical prescriptions to be forged or stolen.

Having prescriptions sent directly to pharmacies reduces potential for fraud and abuse, but it also leaves patients unable to take their prescription to multiple pharmacies in search of the best price. If an order needs to be filled at another pharmacy, only a doctor can cancel a prescription and must do so via phone.

The E-Prescriptions process allows for certain exceptions such as when medications will be filled in another state or if technical issues arise. Doctors can also issue a written or oral prescription for a five-day or less supply of a controlled substance if using the electronic prescription process is impractical and a delay would result in adverse medical impacts.

Minnesota implemented a similar requirement in 2011; however, New York’s law is the first with teeth, actually providing penalties for non-compliance. Ultimately, while the E-Prescription process creates certain new burdens on doctors, pharmacies, and patients, it has the potential to cut down on prescription drug abuse and prevent future opioid addictions. While New York’s law might attenuate various factors related to opioid abuse, it is one of a large number of interventions aimed at combatting the opioid epidemic including increased access to evidence-based addiction treatment, overdose prevention through increased access to naloxone, among other prevention efforts.

This post was prepared by Matthew Saria, student researcher, Network for Public Health Law – Western Region, and Kim Weidenaar, J.D., Deputy Director, Network for Public Health Law – Western Region at the Sandra Day O’Connor College of Law, Arizona State University.  

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to RWJF.

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