States get feds' help with Rx monitoring

More than 90% of all physicians soon could be practicing in a state with prescription monitoring.

By Andis Robeznieks — Posted Nov. 1, 2004

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

In a federal budget totaling $2 trillion, a $16.5 million program might seem like a drop in the ocean. To cash-strapped state governments, however, receiving their share of this pool of money has made a huge difference in getting programs to monitor prescriptions for drugs of potential abuse up and running.

The first such program was started by California in 1939, but the rest of the country was slow to follow suit. Now the roster of monitoring states is rapidly growing, thanks in part to the federal prescription-monitoring grant program that has allocated $16.5 million between 30 states over the last three years.

"While it took 60 years to establish the first 15 programs, seven new programs will be up and running just three years after the Harold Rogers prescription drug-monitoring program was created," said Leslie Cupp, communications director for U.S. Rep. Harold Rogers (R, Ky.), the congressman who started the program. "That's nearly a 50% increase attributable to this program."

The competitive grant program directs money to states for starting or planning new programs or for enhancing existing ones. The grants cannot be used to operate a program.

In Rogers' home state, there is support for the Kentucky All-Schedule Prescription Electronic Reporting, which was started in 1999. "We have resolutions and policy to expand the program when revenue becomes available," said Marshall E. White III, Kentucky Medical Assn. director of public and governmental relations.

Next year's funding undetermined

In 2004, 23 states and the Alexandria, Va.-based National Alliance for Model State Drug Laws split $6.9 million in federal grants. In 2003, nine states and the NAMSDL divided up a $2.85 million pool. Funding for 2005 remains in question, Cupp said. The House approved $10 million for the program, but the Senate has provided no funding at all.

A lack of funding could put a significant crimp in states' efforts to monitor prescribing.

"For any issue, one of the first things we hear is, 'Who's going to fund it?' " said Larry Lewis, aide to New Jersey Assemblyman Herb Conaway, MD, sponsor of his state's monitoring bill. "We've had back-to-back billion-dollar deficits, so, with federal grants, people are more receptive."

Medical Society of New Jersey spokesman John Schaffer said the MSNJ had not formulated an opinion on Dr. Conaway's bill yet, explaining that it thinks preventing doctor-shopping by drug abusers is a good idea, but having the state play "big brother" and watching over physicians' prescribing histories might not be.

Cupp said 22 states would have programs in place by the end of 2004, but three more also could start programs if pending legislation gets approved.

U.S. Drug Enforcement Administration spokesman Rusty Payne said about 59% of all doctors and 56% of pharmacies operate under monitoring programs. He said these figures could grow to 92% and 91% if states that have received grants or introduced monitoring bills start programs.

Nevada program praised, copied

Initiated in 1995, Nevada's program is operated by the state pharmacy board and is often copied as a model by smaller states. Las Vegas internist and Nevada State Medical Assn. President-elect Warren H. Evins, MD, said this was a good idea because his state's program had been effective and helpful, particularly during his part-time urgent care duties at a local hospital.

"In urgent care, I'm seeing people I've never seen before. Many of them want controlled substances, and I'm interested in their history and usage," Dr. Evins said.

If he requests a patient's prescribing profile, Dr. Evins said other physicians listed on the profile are notified about the patient's attempts at doctor-shopping. "There's nothing that restricts the doctor from writing a prescription," he said. "I don't think it prevents legitimate patients from getting controlled substances."

AMA Council on Scientific Affairs Chair Melvyn Sterling, MD, who spoke at a program with DEA representatives at the AMA Annual Meeting in June, said there is no formal AMA policy on prescription monitoring but said he thought it should "remain under the purview" of doctors.

"It's almost a no-brainer. Law enforcement agents do not take courses in anatomy, physiology or pharmacology, they take courses in law enforcement," Dr. Sterling said. "Law enforcement should not be the primary oversight mechanism."

Amy Powell, deputy director of the National Alliance for Model State Drug Laws, said that when investigations do occur, prescription monitoring helps make them more discreet. "If there is an investigation, law enforcement doesn't have to go to the local ma-and-pa pharmacy and -- for lack of a better phrase -- make a scene," she said.

The nation's most heated prescription-monitoring battleground state has been Florida, where legislation has been blocked three times.

Pain patient and privacy advocates helped stall this year's monitoring bill despite strong political support from Gov. Jeb Bush and financial support from two Harold Rogers grants and money from OxyContin manufacturer Purdue Pharma. The Florida Medical Assn. initially opposed monitoring, but legislators have worked with the group to eliminate its objections, said FMA Director of Governmental Affairs Francesca Plendl.

"It's not something we're working on to get passed, it's something we're trying to make into a good bill that we're OK with it passing," Plendl said. "Still, you can't get past the basic tenet that there will be a large amount of health care information kept in a database controlled by the state. Libertarian types don't like that, and I don't blame them."

Back to top


Grants help expand Rx monitoring

Former Drug Enforcement Administration Administrator Asa Hutchinson's March 2002 call for all 50 states to develop prescription-monitoring programs did not appear to be met with much enthusiasm by cash-strapped state governments. But with the help of $16.5 million in grants from the federal Harold Rogers Prescription Monitoring Program, the number of states with such programs could nearly double.

States with existing programs: California, Hawaii, Idaho, Illinois, Indiana, Kentucky, Massachusetts, Michigan, Nevada, New York, Oklahoma, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington and West Virginia

States with new programs: Alabama, Iowa, Maine, Mississippi, New Mexico, Tennessee and Wyoming

States that received grants but haven't started programs: Colorado, Connecticut, Florida, Kansas, New Jersey, North Carolina, Ohio, Oregon and South Carolina

Note: Virginia and Washington have partial programs.

Source: DEA

Back to top

Not unanimous on national database

The U.S. House of Representatives not only approved $10 million to fund the Harold Rogers prescription-monitoring grant program in 2005, it also passed the National All Schedules Prescription Electronic Reporting Act to create a national database -- supported by individual state databases -- to track all narcotic prescriptions.

At least one congressman is strongly opposed to the measure.

"By creating a national database of prescriptions for controlled substances, the federal government would take another step forward in the war on pain patients and their doctors," Rep. Ron Paul, MD (R, Texas), said on the House floor Oct. 5.

"Once doctors know that there is a national database of controlled substances prescriptions that overzealous law enforcement will be scrutinizing to harass doctors, there may be no doctors left who are willing to treat chronic pain," Dr. Paul said.

Both measures are now awaiting Senate action.

The American Medical Association has not taken a position on the legislation.

Back to top

External links

"Aspects of Pain Management in Adults," Report 4 (A-95) of the AMA Council on Scientific Affairs (link)

Harold Rogers Prescription Drug Monitoring Program, U.S. Bureau of Justice Assistance (link)

"A Closer Look at State Prescription Monitoring Programs," U.S. DEA Diversion Control Program (link)

Thomas, the federal legislative information service, for bill summary, status and full text of the National All Schedules Prescription Electronic Reporting Act (HR 3015) (link)

"Reject a National Prescription Database," remarks by U.S. Rep. Ron Paul, MD (R, Texas) on the House floor Oct. 5 (link)

"AMA decries RX drug abuse, supports pain relief," AMA news release, March 1 (link)

About the AMA position on pain management using opioid analgesics (link)

National Alliance for Model State Drug Laws (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn