Federal law aims more money at curbing prescription drug diversion

This fall's federal budget negotiations could net states as much as $60 million in grants to help them set up or enhance prescription-monitoring programs aimed at cutting down on the diversion of controlled drugs to the illegal market. The money is courtesy of a new law.

The Senate was unanimous in its support of the bill, the National All Schedules Prescription Electronic Reporting Act of 2005, or NASPER, and it passed the House of Representatives on a voice vote. President Bush signed the bill July 29.

Congress will determine how much money actually to allocate to the program. If funding is approved, states could start drawing on the $60 million pot in fiscal year 2006, and the money would be available through 2010.

On average, it costs $350,000 for a state to operate a prescription-monitoring program, says the Drug Enforcement Administration. But start-up costs can go much higher, with Kentucky spending $850,000 to gets its program off the ground in 1999.

Each state applying for funding would receive the same base amount, but an additional amount would be determined by the Health and Human Services Dept. The additional amount would be allocated based on the state's budget cost estimate to start or operate the program, and the number of pharmacies in the state.

Some supportive; others leery

Several physician groups, including the AMA, supported the bill. Physicians see it as a way to provide doctors with more information about the patients who come to them seeking controlled substances.

"By providing physicians with access to important patient information, they can effectively treat their patients' pain or illness while helping to prevent the abuse and diversion of controlled substances," said AMA Executive Vice President and CEO Michael D. Maves, MD, MBA. "This principle of 'balance' between access to necessary pain medication and the prevention of abuse has long been supported by the AMA."

Twenty-one states have prescription monitoring programs in place, though not all of them cover Schedule II-IV drugs as NASPER now requires. State law enforcement administers seven of the state programs; 14 are run by other bodies, usually pharmacy boards or health departments.

The American Society of Interventional Pain Physicians also supports the new law, which requires participating states to share prescription data with law enforcement officials, doctors, pharmacists and other states.

"Many physicians have been adversely affected either through medical liability actions or licensure sanctions, through no fault of their own," said John Prunskis, MD, co-director of the Illinois Pain Institute and secretary of the Illinois Society of Interventional Pain Physicians. NASPER, he said, would give physicians a useful tool to avoid legal trouble.

"The thing to remember is that doctors are the only ones who don't have this information," said Roger Cicala, MD, of the Memphis, Tenn., Semmes-Murphy Neurologic and Spine Institute and a board director for ASIPP.

NASPER would hasten an eventual scientific analysis of prescription data and help physicians gauge whether they may be over- or undertreating their patients as compared with their colleagues, Dr. Cicala said.

While several groups support the law, others are not so sanguine. The American Academy of Pain Medicine and the American Pain Foundation, a patient-advocacy group, both supported the bill more out of cold realism than enthusiasm. They pushed successfully to have the HHS administer the program instead of the DEA and to have HHS study the law's effectiveness over a two-year period and report its findings back to Congress.

Studies have shown that earlier paper-based state efforts at combating diversion had a chilling effect on doctors' willingness to prescribe medically appropriate controlled substances, said Scott Fishman, MD, chief of pain medicine at the University of California, Davis and the American Academy of Pain Medicine's president.

"An honest HHS study will reveal that some [prescription-monitoring programs] are very good and some are very bad," Dr. Fishman said. The specter of law-enforcement scrutiny, especially in the context of a rash of recent prosecutions of doctors, can lead to undertreatment of bona fide pain patients, he said.

"We're kind of shooting blindly here," said Matt Bromley of the American Alliance of Cancer Pain Initiatives. "We're blindly trusting that these programs won't have any effect on patients' access to pain care."

According to the American Pain Society, a research group, 50 million Americans live with persistent pain and about 10 million live with constant, severe pain.

An effort similar to NASPER called the Harold Rogers Prescription Monitoring Grant Program has been funded with $26 million since 2002 and is run by the DEA. The Harold Rogers program has handed out money to 23 states so far, but because funding must be approved annually by Congress, some states have been reluctant to sign on for fear that the money would suddenly disappear.

NASPER doesn't require states to set up prescription-monitoring programs, but it does require any state asking for money to ensure that its system can share prescription data with at least one other state. The hope is that states will agree on how to share data nationwide, thus making it easier to control the diversion that law enforcement officials say is rampant along state borders. States are eligible for funds from both programs.

"NASPER certainly does have support," said Amy Powell, deputy director for policy and strategy at the National Alliance for Model State Drug Laws. "There's nothing to prevent both programs from getting money [from Congress]," she said.