Staten Islanders have been going off the Island to get prescriptions for pills.
Staten Island Advance photo
STATEN ISLAND, N.Y. - Staten Islanders are heading out of the borough in droves to receive and fill prescriptions for the oft-abused painkiller oxycodone, with more than one out of every five scripts written to an Islander coming from the pen of an off-Island physician, according to an analysis of state Health Department data.
State data shows that in 2012, borough residents received 141,481 prescriptions for the painkiller -- far outpacing the rest of the city in prescriptions per capita.
Yet physicians here wrote out 110,327 prescriptions for the drug in 2012, meaning at least 31,000 of Islander's scripts, possibly more, come from off-Island doctors.
Similarly, pharmacies here filled out 122,048 oxycodone prescriptions in 2012, showing that the borough's residents went off-Island to fill at least 19,400 of their scripts.
THE HEAT IS GROWING
Law enforcement sources here say that as the borough's prescription drug abuse epidemic gets more and more public attention addicts and criminals are discovering it increasingly difficult to get doctors here to write new prescriptions for oxycodone, or find pharmacies willing to fill those scripts for new patients.
That could be pushing people off-borough, or out of state, to get their prescriptions.
"I think we're all reluctant," said one leading Island doctor.
Others point out, though, that the discrepancy might stem from the fact that Manhattan has far more hospitals than Staten Island.
Many of those hospitals deal with specialized care and procedures -- like orthopedic surgery and cancer treatment, said Dr. Theodore Strange, associate chairman of medicine for Staten Island University Hospital and vice president of medical operations for the facility's south site.
"How much of that there is, I can't answer you," he said, but he suspected that patient "out-migration" plays a large part in the 31,000 prescription discrepancy on Staten Island.
The data doesn't show specifically where those 31,000-plus prescriptions were written, though it does indicate a trend among the city's five boroughs.
In Manhattan, residents received just 264,271 prescriptions for oxycodone last year, but doctors there wrote out nearly twice as many scripts there -- 514,819 in total.
The trend goes the other way in the city's other three boroughs, with the number of prescriptions written to residents outpacing the number of prescriptions written by doctors. For Bronx residents , at least 30 percent of oxycodone scripts were written by outer-borough doctors, while that number in Queens and Brooklyn is 25 percent and 15 percent respectively.
On Staten Island, that number lands at about 23 percent.
Manhattan is home to 20 hospitals sites, compared to just four on Staten Island. Brooklyn has 15, the Bronx 11, and Queens 9.
Luke Nasta, the executive director of Camelot Counseling Services, says that the addicts his agency treats still say that Island doctors are primarily the ones writing Island prescriptions.
"We're still hearing Staten Island doctors... However, doctors are being more conscientious about who they're giving the prescriptions to, for what diagnosis, and the numbers," Nasta said. "The doctors are getting the message. They're still in a very conflicted position because when people require pain medication, that's what they're called on to do."
Nasta said that years of "superb marketing" on the art of drug manufacturers has in part placed doctors in that position.
"You rate your pain as one of your vital signs -- that's brilliant. That's kind of -- the guy that invented the atomic bomb, it's that level of brilliant," he said.
M.D.'S MORE WARY
Though SIUH's Dr. Strange said he hasn't heard of patients going off-Island to find less wary doctors, he acknowledged that physicians are more cautious about writing prescriptions for oxycodone and other widely-abused medicines.
"I think we're all reluctant. We've all become reluctant to prescribe Schedule II medications and beyond," he said.
As for the number of prescriptions written for painkillers like oxycodone and hydrocodone, anti-anxiety medications like Xanax, and sleep aids like Ambien, Dr. Strange said, "I bet you, Aug. 27, you'll start to see a significant change."
He's referring to when the state is mandated, by law, to launch a real-time prescription database that all doctors must check before writing scripts for controlled substance. The so-called I-STOP database is meant to curtail the practice of "doctor-shopping" by showing physicians whether the patient in front of them has already received prescriptions from other doctors.
NEW LAW'S IMPACT
Dr. Strange said that while the concept of the law is sound, he's apprehensive about how the new database will be implemented, and suspects that it'll add 15 to 20 minutes to each patient's doctor visits.
That might mean doctors will pass patients over to pain management specialists, or forgo writing certain prescriptions entirely, except in cases of life and death, if the database proves unwieldy. Another portion of the law requires the state switch from paper prescriptions to an electronic system, and that may take some of the sting out of the process, he suggested.
"It's yet to be seen how this is going to affect the process," he said.
Nasta, meanwhile, says addicts tend to find other sources to tide them over if one path to getting drugs dries up.
"By the time they get to me, they're not saying it's hard to get," Nasta said.
Often, he said, they'll "fall back" to getting Suboxone, which is prescribed to treat opiate addiction, then wait for a new source to present itself, or, barring that, sell the Suboxone themselves to buy more pills, or heroin.
Though I-STOP is a good first step, he said, if supply dries up, "Everybody who's been using for the past 10 years, they aren't going to stop. They're going to heroin."