Department of Health
Selected Operating and
Administrative Practices of the
Bureau of Narcotic Enforcement
Issued: November 21, 2012
Link to full audit report 2011-S-19
Purpose
To determine whether the Bureau of Narcotic Enforcement (Bureau) is effectively and efficiently
combating prescription drug diversion and abuse in New York State. The audit covers the period
April 1, 2007 through March 8, 2012.
Background
Illegal use of prescription drugs is an escalating problem that drives up healthcare costs and
threatens the safety of all citizens. So great is the problem that the Centers for Disease Control
and Prevention has classified abuse and diversion of prescription drugs as an epidemic and the
nation's fastest growing drug problem. The underground market for these drugs is fueled in
large part by individuals and criminal groups who use fraudulent tactics to acquire powerful and
addictive medications, including painkillers like Oxycodone, Fentanyl or Morphine; stimulants
like amphetamines or Ritalin; and hypnotic drugs and sleep aids like Ambien. The Bureau is
responsible for combating these illegal activities by overseeing the State's Official Prescription
Program and investigating suspected cases of drug diversion and abuse. To this end, it maintains
a database of all New York State prescriptions used to acquire controlled substances.
Key Findings
The Bureau has a significant amount of information and resources at its disposal to combat illegal
drug activity. Our audit identified several areas where improvements are needed to ensure these
resources are used effectively to stem the growing problem of prescription drug diversion and
abuse through a range of efforts from prevention and deterrence, to detection and prosecution.
- By applying data mining techniques to 15 months of the Bureau's prescription data, we culled more than 565,000 filled prescriptions that contained errors or inconsistencies. These include 67,000 prescriptions for drugs like Oxycodone, each potentially used multiple times for a total of almost 180,000 transactions at different pharmacies and/or containing different information about the prescribers or the drugs involved. While we recognize further assessment and refinement of the data is needed, analyses like this can pinpoint patterns and relationships that identify criminal activity.
- The Bureau does not always properly secure or monitor returned prescription forms. As a result, data shows thousands of unused forms, supposedly destroyed, may actually have been used to obtain controlled substances.
- The Bureau's previous management failed to establish consistent investigative priorities among its regional offices, making the Bureau less effective in detecting and ceasing criminal conduct.
- Some Bureau funding was used for other activities or should have been used more efficiently, including over $43,000 of computer equipment purchased several years ago, the majority of which was still not in use by the end of 2011.
During our audit, we provided Department officials with preliminary findings detailing our
observations and recommendations. At the conclusion of our fieldwork and shortly thereafter,
the Department announced several changes to Bureau operations including installation of new
leadership, implementation of new data mining strategies and plans to eliminate the paper-based prescription system for controlled substances. These positive steps should help address several
of the challenges discussed in this report. However, further improvements are still needed to
maximize the Bureau's ability to combat the growing problem of prescription drug diversion and
abuse.
Key Recommendations
- Further review the prescription data identified by our audit to isolate instances and patterns that warrant formal investigation.
- Modernize the Bureau's use of technology and information resources by expanding routine data analysis to assist in more effectively identifying and investigating prescription drug diversion and abuse.
- Properly account for, safeguard and monitor the destruction or other disposition of prescription forms returned to both the Bureau and its contracted supplier.
- Establish and communicate clearly defined and consistent priorities, objectives and goals to guide regional investigations. Monitor outcomes to determine whether investigators and offices are meeting expectations.
- Monitor and reconcile expenditures to ensure that funding is used as intended.
In responding to our draft report, officials acknowledge both the value of data mining and analysis, and that their own subsequent testing has shown some of the records we cited were related to specific instances of suspected criminal activity. Officials also reported they plan to expand the Bureau's analytical staff to conduct more in-depth analysis to address diversion. Officials also reported actions taken to better account for returned prescription forms, oversee statewide investigative activities, correct previously identified problems, and control the use of Bureau funding. At the same time, the Department's response also includes several statements that minimize the significance of the findings from our analysis of prescription data.
Auditor Comment
When looking for fraud and abuse, officials should expect that only a very small percentage of
transactions will be problems and specific tools, like data mining and analysis, are necessary to
highlight the ones that pose the highest risk. Considering the vast number of prescriptions filled
for these controlled substances, we caution that officials should not be too quick to dismiss the
impact of even a small percentage of problems; especially when only one-half of one percent could
translate into 100,000 instances each year where dangerous drugs are dispensed improperly. Our
specific rejoinders to some of the Department's statements are presented as State Comptroller's
Comments at the end of this report.
Other Related Audits/Reports of Interest
Department of Health: Office of Professional Medical Conduct Complaints and Investigations
Process (2008-F-29)
State Government Accountability Contact Information:
Audit Director: John Buyce
Phone:(518) 474-3271; Email: StateGovernmentAccountability@osc.state.ny.us
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236
