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November 21, 2012

 

Audit Spurs Improvements At Health Department's Bureau of Narcotic Enforcement

DiNapoli Calls for More Consistent Statewide Approach

The State Health Department's Bureau of Narcotic Enforcement tightened processes for combating abuse of prescriptions for controlled substances during an audit by the State Comptroller's office that ultimately found hundreds of thousands of prescriptions that may have been abused, poor controls over unused prescription forms and significant variations in bureau drug investigation practices across the state.

"The abuse of prescription medications has reached epidemic proportions and the costs to society are enormous," DiNapoli said. "Attorney General Schneiderman deserves credit for spearheading a statewide electronic prescription drug database, I-STOP, that will help to crack down on prescription drug abuse. I commend Governor Cuomo and his team for making leadership changes that are moving the Bureau of Narcotic Enforcement in a positive direction. The bureau needs to aggressively pursue new ways to prevent, detect, investigate and prosecute illegal prescription activities."

The bureau is the state Department of Health's (DOH) lead office charged with combating the illegal use and trafficking of controlled substances in New York.

DiNapoli's auditors examined 28.5 million prescriptions dispensed over a 15-month period and found more than 325,000 prescriptions for controlled substances, filled more than 565,000 times, contained errors or inconsistencies in critical information.

Zolpidem (a drug sometimes marketed as Ambien), Oxycodone (a pain medication commonly marketed as OxyContin), and Hydrocodone (a pain medication sometimes marketed as Vicodin) accounted for nearly half of the drugs acquired with these prescriptions.

Auditors found:

  • More than 130,000 instances where data showed that the prescriptions used to obtain controlled substances contained an invalid Drug Enforcement Administration registration number that did not match the prescriber;
  • Almost 180,000 instances where prescription numbers appeared more than once in the data, having been filled at different locations or with inconsistent information about the prescriber or the drug dispensed;
  • More than 90,000 prescriptions were refilled more than 157,000 times beyond their authorized refill quantities. This included almost 12,000 prescriptions for Schedule II controlled substances that were refilled more than 17,000 times even though these types of medications are not allowed to be refilled at all because they are the most dangerous and highly addictive drugs allowed to be prescribed in New York; and
  • 135 instances where prescriptions had been written by practitioners whose licenses had been revoked, suspended, surrendered or otherwise inactivated.

DOH contends that many of these questionable prescriptions were likely attributable to data entry errors. The bureau was able to identify what it believes are the likely causes of about 50,000 discrepancies.

Auditors also found the bureau's five regional offices did not have a consistent approach for what they investigated, which resulted in inconsistent outcomes. For example, the Syracuse office accounted for half of the bureau's completed cases that resulted in criminal charges, while the Buffalo office produced less than 10 percent. In contrast, the Buffalo and Rochester offices together generated about 80 percent of the cases that resulted in civil penalties and administrative warnings, while the New York City office had none.

Auditors determined that the bureau relies heavily on external tips and sources as the starting point for the majority of its cases and much less on data mining techniques that can be more effective in identifying suspicious activity. In response to the audit, the new director of the bureau has recently implemented new data mining strategies and officials say they plan to assign additional resources to conduct these analytic techniques. The bureau's full response is included in the audit.

Additionally, auditors found that returned and unused prescription forms were not always properly secured and accounted for. Auditors examined a box that had not been properly inventoried and kept inside a locked cabinet as required and found 2,034 prescriptions that had not been logged in, including 1,500 pieces of blank electronic medical record paper which could easily be made into counterfeit forms. Over 4,000 returned forms maintained by a DOH contractor that were supposedly destroyed showed up in the bureau's records as being used to obtain controlled substances.

Auditors recommended the bureau:

  • Increase its use of advanced analytical techniques to pinpoint possible cases of drug diversion;
  • Pursue crimes with a consistent and coordinated approach across the state; and
  • Secure and account for unused prescription forms.


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