By Hazel Trice Edney –
Six years ago, public health officials in New York embarked on an ambitious plan to develop a prescription-drug monitoring program to stem the abuse of psychotropic medications used to treat mental illness, particularly given the growing market for powerful antipsychotics like Seroquel, as well as antidepressants like Prozac and drugs used to treat hyperactivity disorder, including Adderall and Ritalin.
But after tens of millions of dollars, the project appears to have ground to a halt, mired in what several sources say is a contracting dispute between the New York Office of Mental Health (OMH) and a vendor that designs software for the program.
Now, the situation is causing concern among mental-health experts, substance abuse counselors and patient advocates at a time when estimates show that one in five adults now take at least one psychotropic medication.
The situation has the potential to impact the African-American community especially hard, given the growing awareness of the community’s acute need for reliable and sound mental-health care. Consider that adult African-Americans living below poverty are three times more likely to experience serious psychological distress than those living above poverty.
Also, historically, communities of color have experienced unique and considerable challenges in accessing mental health services. Those challenges are compounded by other historic factors, including slavery, sharecropping and race-based exclusion from health, educational, social and economic resources.
The prescription-drug monitoring program that New York has been attempting to put in place is similar to efforts undertaken in other states, where electronic drug monitoring databases were designed and then put in place to reduce prescription drug misuse, abuse and diversion.
This approach appears to be paying off. When federal data began to show a sudden drop in opioid-related mortality rates last year, many public health experts and addiction counselors were quick to credit the proliferation of prescription drug monitoring programs (PDMPs) that 49 states have implemented in recent years.
Indeed, among the 49 states requiring doctors to check registries before writing opioid prescriptions, incidents of “doctor-shopping” have been in sharp decline. As a result, the number of monthly prescriptions for drugs like oxycodone, hydrocodone and codeine has been steadily shrinking for eight consecutive years, according to public estimates.
Mental health advocacy groups say the standoff in New York reflects turmoil that the New York Office of Mental Health (OMH) has experienced in recent months for a number of reasons, including high-profile scandal, like the indictment of a high-ranking officials on 29 counts of child endangerment last fall.
The drug-monitoring program was unveiled in New York with high hopes. In 2013, the OMH engaged a Montreal-based information technology firm, CGI, to deploy an electronic health-record system connecting its 24 hospitals and 310 clinics. The $48 million contract called for a system based on one that has been successfully used by the Veterans Affairs Department.
State officials predicted “Empire State Vista” would be among the largest agency-run electronic health record system in the country, promising it would dramatically improve communication and record-keeping among state-run hospitals and outpatient clinics. And the project has seen some progress with all facilities, prior to CGI’s termination, utilizing the pharmacy management system software, according to experts who have been closely monitoring the program’s implementation.
Gerry Engel, the State’s project manager, described the project in June 2017 as “the largest hospital installation of Vista” that, at the time, was “just finishing up track one now…and getting ready to implement track two and hope to be just as successful at that,” according to a videotape of a speech Engle gave at a conference.
The project was expected to take four years to complete. At the end of the four years, both parties agreed to a two year, no-cost extension due to natural delays in technology projects, according to individuals familiar with the program.
But then, the state suspended and then terminated the contract in August 2018 without any further explanation, according to those individuals. As a result, CGI has filed suit against the State, arguing that it is owed money for work performed.
Perhaps more troubling for residents in the state, CGI has also filed a restraining order to prevent OMH from accessing the software currently in use at several facilities as it represents intellectual property that the state does not own and has not paid for.
To complicate matters further, several sources say, OMH may initiate the process of hiring a new contractor to implement the monitoring program – a move that means the effort could end up essentially starting from scratch.
Some fiscal watchdogs and mental health advocates are increasingly concerned.
“Substance abuse among patients with mental health needs is just as much a public health emergency as the opioid epidemic,” said one mental health professional engaged in the discussions with CGI and the state.
Patients with mental health needs are dramatically more likely to struggle with not only homelessness, poverty and social isolation, but also substance abuse. Rates of doctor-shopping are higher among individuals suffering from mental illness, they say, and patients with mental illness tend to gravitate toward addictive drugs such as opioids, benzodiazepines (e.g. Valium, Xanax) and amphetamines.
The conclusion of the mental health professional have discussions with CGI and the state is that a new start could possibly be disastrous: “After six years, and tens of millions of dollars spent with the finish line finally in view, it’s hard to see how starting over would benefit either the taxpayers or at-risk patients who depend on the state for mental health treatment.”