States consider requiring physicians to use drug-monitoring databases

At least two states have legislation pending that would require physicians to access computerized drug monitoring databases every time they write a prescription for a controlled substance.

Backers of at least one of those bills -- one of two proposed in Tennessee -- acknowledge that the bill is unlikely to pass as is. But they -- and backers of a similar bill in New York -- say the legislation reflects a need for states to address the fact that the databases are being underused by physicians.

New York officials found that of the 80,000 health care professionals licensed to prescribe pain medications and other controlled substances, only 47,000 have opened an account that would grant them access to the database that went live in February 2010. As of November 2011, only 2,216 had used the system.

Attorney General Eric Schneiderman issued a report on Jan. 11 showing that the number of prescriptions for narcotic painkillers in New York increased from 16.6 million in 2007 to 22.5 million in 2010.

Schneiderman drafted a proposed bill that would require the Dept. of Health to establish and maintain a database capable of real-time information capture. Schneiderman's proposal would require a check of the database every time a physician writes a prescription for a schedule II, III, IV, or IV controlled substance. Assemblyman Michael Cusick, a Democrat from Staten Island, and State Sen. Andrew Lanza, a Republican from Staten Island, are sponsoring the proposed bill.

The portion of the bill regarding a real-time database is meant to address a flaw in databases -- the information often is updated in an inconsistent and untimely manner.

What monitoring programs cover and how often they are updated vary from state to state. But generally, a physician is assigned a login and password to a database that shows what prescriptions a patient has filled and who has prescribed them. The information can be used either to initiate addiction treatment or to report illegal activity.

Increasing awareness

Some states are trying to improve educational efforts to make physicians more aware of the databases and create best practices for using them. Other states are focused on improving the technology so doctors can get information in a more timely and efficient way. Meanwhile, some states have enacted laws mandating use of the database in certain circumstances.

Tennessee and New York are taking a big step by considering legislation making the use of databases mandatory before all prescriptions for controlled substances are written.

"As you can expect, that's a highly controversial move," said Sherry Green, executive director of the National Alliance for Model State Drug Laws. "But it tells me that the seriousness of the prescription drug problem in some states is reaching a level of people feeling like, 'We have to do something, and this is the approach we are taking.' "

An estimated 20 million Americans 12 and older have used prescription drugs for nonmedical reasons, according to the National Institutes of Health. Forty-eight states have enacted legislation to create a prescription drug monitoring program to help combat the rising epidemic, according to the National Alliance for Model State Drug Laws. Thirty-seven of those states have a program up and running, but several have found use of the system is either very low or not keeping pace with the abuse the programs are meant to detect and reduce.

"Almost every state I've talked to is trying to find a way to increase use of [prescription drug monitoring programs] by prescribers, but in an appropriate way," Green said.

Tennessee's approach

Tennessee has seen some success from its program with an increase in the number of physicians using the database, and a decrease in the number of controlled substance prescriptions written. But as a state that regularly sees its per-capita prescription drug-use rate much higher than the national average, legislators there would like even more improvements.

Two proposed bills would expand the mandate to all prescribers in Tennessee. One is a proposal by Gov. Bill Haslam's office, the other by State Sen. Ken Yager.

Summer Carr, a research analyst for the state and local government committee for Yager's office, said the state senator proposed a bill that would require physicians to check the database for every patient every time a schedule II, III, IV or V controlled substance is prescribed.

"We realize it will probably have to be amended to be a little less strict than that, but we wanted to start the conversation with this bill," she said.

The governor's proposal included some of the same language but included a requirement for prescribers and drug dispensers to report information on all dispensed controlled substances to the database every 24 hours. Current state laws require those who dispense drugs to report only once a month.

The approach advocated by Green, of the National Alliance for Model State Drug Laws, is similar to what is being done in Ohio. There, it's up to the medical licensing boards to issue rules for how the database is used, she said.

Green said many states with mandates have focused on prescribers at pain management clinics. In Tennessee, for example, a regulation that went into effect Jan. 1 requires physicians at pain management clinics to check the database for all new patients and every six months thereafter.

The Tennessee Medical Assn. supports the current rules regarding pain clinics, but it probably would not back a universal mandate of checking the database every time a controlled substance is prescribed, said Gary Zelizer, director of government affairs for the association.