A new online tracking system, approved by state health regulators on August 11, will help pharmacists and physicians fight the growing problem of prescription drug abuse.
The new system also should prove helpful for law enforcement agencies fighting drug dealers who obtain prescription painkillers to sell for profit.
One of the prescription monitoring system’s primary purposes is to tighten controls that stop patients with drug addictions who “doctor shop,” the Boston Globe reported on August 12. Such patients go from doctor to doctor trying to dupe those they haven’t seen before into prescribing narcotics and other powerful painkillers.
At least 9,000 Massachusetts residents are suspected of “doctor shopping” annually, Alice Bonner, director of the state’s Bureau of Health Care Safety, told the Globe.
“The practice has fueled a surge of drug-related deaths over the past decade in Massachusetts, where abuse of painkillers poses a health threat that rivals heroin and other street drugs,” the Globe article said.
At Martha’s Vineyard Hospital, a state-of-the-art medical records system already provides safeguards to alert physicians to a patient’s current prescriptions and medication history.
After Martha’s Vineyard Hospital (MVH) became an affiliate of the Massachusetts General Hospital (MGH) and a member of Partners HealthCare in 2007, staff physicians switched over to Partners’ secure state-of-the-art medical records system.
Instead of relying on paper records in manila folders, MVH outpatient physicians now use the Longitudinal Medical Record (LMR), a web-based ambulatory electronic health record, in their offices.
Doctors are able to retrieve a patient’s complete medical file electronically, including past history, immunizations, medications, medical problems, test results, and physician notes by date entered. It also links records of a patient’s visits to other Partners HealthCare facilities.
The LMR system allows physicians to send prescriptions electronically directly to a pharmacy and alerts them of any possible complications due to patient allergies or drug interactions. For patients who see multiple doctors, the LMR system also provides an alert when a prescribed medication might conflict with one prescribed by another office.
Prescriptions for certain categories of drugs such as narcotics may be entered electronically into the LMR system, but also must be given to patients on a written form, MVH director of physician services Jay Ferriter explained.
The LMR includes software for printing prescriptions with a microprint that identifies that they came from a physician from the hospital, as a safeguard for pharmacists to verify its authenticity.
Mr. Ferriter said although he doesn’t know exactly yet how the new state tracking system will be utilized by hospital staff or what it will involve, at the very least the list of drugs requiring micro-printing through the LMR system may need expanding.
The Public Health Council, an appointed panel of physicians, public health specialists, and consumer advocates, unanimously approved new measures to beef up regulations in the Massachusetts Prescription Monitoring Program (PMP).
The PMP in place since 1992 covered only one category of drugs, which includes OxyContin, Percocet, and morphine. Health providers do not have direct access to its data. Instead, when the Massachusetts department of public health detects worrisome patterns in prescriptions for those drugs, it contacts physicians, and in some cases, law enforcement.
Starting next year, the expanded tracking system approved by the Public Health Council will allow physicians, nurse practitioners, and pharmacists to review an online database to see if a patient already has filled prescriptions for powerful painkillers such as OxyContin. The database will be updated monthly.
Under the expanded system, pharmacists will be required to alert the state when they fill prescriptions from a broader list of medications, including pain relievers such as Darvon and Vicodin, as well as steroids. Prescription drugs for chronic conditions such as asthma, diabetes, and high cholesterol are not on the list.
A crucial element in the tracking system’s success will be if more doctors and nurse practitioners, other than those involved in pain management, check on a patient’s drug history before writing a new prescription.
Ms. Bonner said authorities would conduct random checks to ensure that information is not misused, and violators could face substantial fines and other penalties.
According to the Globe article, about 9 million prescription orders are written annually for drugs that will fall into the must-report category. Under the new system, the first time a prescription for one of those drugs is filled, the patient or family-member that picks it up must present a driver’s license, passport, or some form of identification.
How prescription monitoring hits home
Island police reacted favorably this week to news of the state’s plan to ramp up prescription monitoring.
“I think this is a huge step in the right direction as far as combating the abuse and diversion of prescription drugs,” Oak Bluffs Police lieutenant Timothy Williamson told The Times in a phone call Tuesday.
He also said the state’s action was long overdue.
“It’s about time the state stepped up and put a check system like this in place,” Lt. Williamson said. “In my fairly short career, I would say that prescription drug diversion seems to be the biggest drug-related problem, and so I’m very happy that they’ve decided to take this step.”
State Police Sgt. Jeff Stone agreed. “We think it’s a great idea and we’re all for it,” he told a Times reporter in a conversation outside XtraMart on Tuesday.
“Prescription drug abuse on the Island is far worse than any other drug problem we’re having,” said Sgt. Stone, who is Martha’s Vineyard’s drug task force coordinator.
In an interview with The Times in December 2007, Lt. Williamson said drug abusers employ several methods to procure prescription painkillers for personal use. Drug dealers use methods of their own to get prescription painkillers to sell for profit. The tactics include faking medical conditions, using altered records such as X-rays, and “doctor shopping.”
Drug abusers go to great lengths and travel long distances to find a doctor who can be convinced, or intimidated, into writing a prescription, according to police. The doctor may be busy or sympathetic and no match for people who know how to play the system.
On Tuesday, Sgt. Stone said he knows of a number of occasions over the last few years where Island residents traveled as far as Florida to visit pain management clinics to “doctor shop” for physicians that would prescribe them additional painkillers and narcotic drugs.
Also, the illegal market for prescription drugs is quite lucrative. A person who pays a very low cost or nothing for prescriptions through a state medical insurance program, for example, could sell an 80-milligram OxyContin pill for $80 on the street, Lt. Williamson said.
For some drug abusers, the problem starts with a prescribed sedative or painkiller on which the person becomes dependent after taking higher and higher doses. And unfortunately, for some teens prescription drug abuse begins with a raid on Mom and Dad’s medicine cabinet at home, both police officers emphasized.
Many young people have the misconception that if a doctor prescribes a medication, it can’t be harmful, Lt. Williamson said.
“But they don’t realize the addictive properties these medicines have, which in some cases, are as addictive as heroin,” he added. “And what happens is these kids do get hooked on these painkillers, and they find that they’re too expensive to obtain or too hard to obtain, and then they end up using heroin to feed their addiction.
“There is certainly a stigma associated with using heroin, but there’s not that initial stigma when you just take some pills that a doctor prescribed to one of your parents that maybe had surgery or something like that,” Lt. Williamson said.
Cooperative Island efforts
Island health providers and law enforcement agents agree that the state’s tracking program should help bolster their ongoing efforts to combat Martha’s Vineyard’s growing prescription drug abuse problem.
In December 2007, following an arrest of a man selling Percocet, a painkiller that had been filled on a local prescription, Oak Bluffs and State Police initiated discussions with MVH officials about how the medical and law enforcement communities might cooperate.
There are roadblocks, however, for law enforcement and physicians that make it more difficult to tackle the problem. Some are rooted in medical and criminal background privacy laws that may make it difficult to acquire or share information.
“We did have a productive meeting with the staff at the hospital, and a lot of good came out of that where we opened some lines of communication,” Lt. Williamson said this week. “Prescription drug abuse and diversion certainly is still a big problem out here, but I think a lot of the doctors are more sensitive to it and more aware of it now.”
“The Island medical community and pharmacists are on board with us,” Sgt. Stone said.