Real-Time Controlled Prescription Drug Monitoring Coming To Your State Soon?

Just this past week, a new regulation went into effect for every prescriber in New York State who orders controlled substances for their patients. The new regulation is called I-STOP, or Internet System to Stop Over Prescribing, and consists on a centralized database where most prescribers must log in to prior to writing a new prescription for a controlled substance and view if any recent controlled substances were written by other providers.

The idea behind the database is if say, a NP is seeing a new patient complaining of severe pain in an urgent care setting, the NP wants to treat the pain with an opiod, they will first consult with the database to see if any prescriptions were recently written by other providers. According to the Center for Behavioral Health Statistics and Quality (2010), approximately “…1,173,654 ED visits involved nonmedical use of prescription medicines, over-the-counter drugs, or other types of pharmaceuticals. This represents about a quarter (23.9%) of all drug-related ED visits and over half (51.0%) of ED visits for drug misuse or abuse. Over half (54.7%) of ED visits resulting from nonmedical use of pharmaceuticals involved multiple drugs, and about one in five (17.4%) involved alcohol.”

In addition, “the most common type of drug involved in ED visits for the nonmedical use of pharmaceuticals was pain relievers (48.3%), with the highest levels seen for the narcotic pain relievers oxycodone, hydrocodone, and methadone (12.5%, 8.2%, and 5.6%, respectively). Drugs used to treat anxiety and insomnia were also seen frequently (34.0%) in visits related to the misuse of pharmaceuticals. Of these, benzodiazepines accounted for the majority (29.5%) of these ED visits, specifically alprazolam (e.g., Xanax®), which was indicated in about a third (10.6%) of visits involving benzodiazepines.”

This represents a significant problem in health care today. New York is among 36 states that has some sort of registry but is among the first to comprehensively tackle this issue in “real-time.” Clinicians will need to significantly alter their practice to comply. There are a few situations allowing exemption which includes:

  • Practitioner administering a controlled substance
  • For use within an institutional dispenser
  • Emergency Department (if limited to a 5 day supply)
  • Practitioner is unable to access in a timely manner (5 day supply)
  • Consultation would adversely impact a patient’s medical condition
  • Hospice
  • Methadone programs
  • Technological failure of PMP or practitioner’s hardware
  • Practitioner has been granted a waiver by DOH based on technological limitations or exceptional circumstances not within practitioner’s control
  • Veterinarians

Prescribers will be faced with scenarios where they may need to directly ask their patient about prior prescriptions where proof exists of recent activity. This can create a rather difficult situation and we must prepare for this situations by having a standard policy or procedure for when this occurs (along with a well thought out script to the seemingly surprised patient). New York’s Department of Health has attempted to help prescribers with these very scenarios by publishing resources on their website.

There are some limitations to the program – namely, there is no interface of the database with electronic health records (EHR). Therefore, even if one is using an EHR, you are required to check this database outside of the EHR environment. There are plans in place to eventually have the database integrate with EHRs.

Undoubtedly,  other states will soon follow this comprehensive overhaul of real-time monitoring and it’s not unreasonable to think that a nationwide (or even more vast) interconnected system will exist. And for those prescribers deciding to skip checking the database, charges against the prescriber can result in license suspension, fines, and even criminal charges.

To read the New York State I-STOP law, click here.


I’m Dr. Stephen Ferrara, a practicing Nurse Practitioner with over 10 years of clinical experience. I’m a senior clinical associate at a large urban hospital system in the Bronx, NY and I’ve owned and operated the largest Nurse Practitioner retail based clinic operation in New York State. I have experience in college, correctional and men’s health.

I have my Bachelor’s degree in Biology and Nursing as well as my Master’s degree, and recently I attained the Doctor of Nursing Practice degree! I’m active within my state’s nurse practitioner association and have lectured at numerous conferences.

In addition to blogging here at, for the past 3 years I’ve authored A Nurse Practitioner’s View. I have a passion for health care technology and integrating evidence-based practice into daily practice.Thanks for stopping by! I hope you find the information on this blog useful for your educational and career endeavors into the field of nursing.