142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Impact of opioid prescriber surveillance on doctor-patient relationships and drug markets

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 1:30 PM - 1:50 PM

Sonia Mendoza, M.A. , Department of Psychiatry & Department of Anthropology, New York University, New York, NY
Helena Hansen, MD, PhD , Department of Psychiatry & Department of Anthropology, New York University, New York, NY
Prescription opioids have been responsible for a staggering increase in overdose deaths over the past decade, and the exponential increase in their use has informed the debate about the medicalization and the pharmaceuticalization of everyday life. Up to now, social mechanisms driving prescription opioid markets and the effects of the prohibitionist drug policies stemming from this epidemic have received little attention. Staten Island is experiencing five times the number of opioid overdose deaths of any New York City borough, and its opioid prescribers have been subject to enhanced law enforcement surveillance. We aim to assess the impact of I-STOP, the prescription monitoring program mandated by New York State in 2013, on doctor-patient interactions, and its impact on the movement of opioid users between legal-clinical and illicit drug markets. Semi-structured interviews and ethnographic observations of physicians and their patients informed our research. Preliminary findings suggest that, because of I-STOP, opioid prescribers report more agency in refusing patient requests, and are more selective in accepting new patients that are at risk of non-medical use. Respondents anticipate an increase in heroin use among those dependent on prescription opioids and increased crossing of state borders to obtain prescriptions. Drug policies that target prescribers for sanctions in an effort to maintain boundaries around “legitimate” medical use of opioids may paradoxically be leading patients to blur the boundaries between medical and illicit drug use, enhancing the interconnections between prescription opioid users and illicit drug vendors.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe prescriber attitudes toward the newly implemented NY state prescription monitoring program. Assess the impact of prescription monitoring programs on patient- provider relationships. Identify prescriber concerns regarding patient care and patient drug use.

Keyword(s): Drug Abuse Treatment, Prescription Drug Abuse and Misuse

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the research coordinator for multiple federally funded research projects involving program evaluations. Among my scientific interests has been community based research and ethnographic field work and my current focus is in prescription opioid treatment settings and patient and provider attitudes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.