States get feds' help with Rx monitoring

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."