Physicians asked to help with Rx abuse-prevention programs

The number of states with prescription monitoring programs doubled in six years.

By Pamela Lewis Dolan — Posted Jan. 28, 2009

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As prescription drug abuse becomes a greater concern among governors and legislators, several states are turning to physicians to help curb the problem through prescription drug monitoring programs. Iowa is the latest state to adopt such efforts.

While the programs have the potential to place physicians in the unwitting position of law enforcement officials, several physician organizations, including the American Medical Association, have expressed support for them. They feel the programs could be a tool for physicians to identify patients in need of help.

According to Sherry Green, executive director of the National Alliance for Model State Drug Laws, there are 38 states with laws authorizing monitoring programs and 32 that have a program up and running. The number of states with monitoring programs has more than doubled since 2002 when the U.S. Dept. of Justice made grants available to create programs.

Under the programs, states create Web sites on which pharmacists report controlled substance prescriptions that are filled. Physicians can gain access to the site to identify possible doctor shoppers or addicts, or even those who might be involved in illegal drug diversion.

Jeanine Freeman, senior vice president of legal affairs for the Iowa Medical Society, said when Iowa received a grant to create a drug monitoring program two years ago the medical society's initial concern was that the program would be established under grant only with no statutory requirement.

"There's too much that comes into play here," Freeman said, adding that patient privacy and physician liability were at the top of the list of concerns from members. It was the medical society's view that the state needed statutory requirements spelling out how the program would be created and used.

"We spent the better part of a year to a year and a half working with the board of pharmacy and regulators to establish a program we thought would work in our state. The law that was designed, we were behind," she said. The state is now in the process of authorizing users and collecting data. Physicians and other prescribers will be able to start requesting data by early March.

According to Terry Witkowski, executive officer of the Iowa Board of Pharmacy, which will facilitate the program and maintain the Web site, pharmacists must report all schedule II, III and IV controlled substances that are dispensed. What the physicians do with the information is up to them.

Russ Miller, executive director of the Tennessee Medical Assn., said the majority of physicians in that state find using the system disruptive to their daily routines. And others, he said, feel the program isn't living up to its potential as the data are only updated twice a month. The medical society is pushing for upgrades to the program that would include real-time reporting.

But those who use it consider it an important component of providing patient care, Miller said.

Some states allow law enforcement officials to access the database, but in many states that's off limits. Green said while none of the programs has mandates that physicians must report what they find, many states have laws that require physicians to report any suspected criminal activity. Under HIPAA, personal information can be disclosed under some exceptions, one of which is reasons of law enforcement. In Iowa, as in other states, physicians aren't required to give specific information, just enough for law enforcement officials to prompt an investigation.

The AMA took up the issue at its 2008 Annual Meeting after several state medical societies asked for its help in drafting proposed state laws. AMA policy advocates that any information found through such databases be used first for education prior to any civil action against any physicians. Possible action could target a physician's prescribing history.

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