More states make doctors consult databases before prescribing

However, physicians are skeptical that the move will reduce prescription drug abuse.

By — Posted June 28, 2012

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Some states are deciding it’s not enough that physicians have access to a database to identify patients who might be doctor-shopping to feed a drug addiction. They are deciding that physicians must check that information before they write certain prescriptions.

Even though the health care community agreed with the intent of such a law passed in Tennessee, there is some skepticism it will have the desired effect without, for example, increasing public education programs about prescription drug abuse. There’s no question the law there will reduce overprescribing and doctor-shopping, said Gary Zelizer, director of government affairs for the Tennessee Medical Association. “The question is whether the juice is worth the squeeze,” he said.

Beginning in 2013, physicians in New York and Tennessee will be required to query prescription drug monitoring databases before an initial prescription is written for controlled substances, then for regular periods thereafter, joining at least three other states that have enacted such requirements.

Forty-nine states have laws establishing prescription drug monitoring program, and 43 of them have a program up and running that involve a database of patients who have been prescribed certain controlled substances. Despite those efforts, prescription drug abuse continues to be a problem. Political pressure is growing to do something about it.

In some states, medical boards have been given more investigative and discipline power to go after physicians deemed to be overprescribing. In 2011, West Virginia and Kentucky have passed laws requiring physicians to consult the state monitoring database before issuing certain prescriptions. In Kentucky, doctors are required to check with an initial script of schedule II drugs and schedule III drugs containing hydrocodone, and in West Virginia, it applies to any pain-relieving controlled substance. That same year, Ohio passed a law allowing the state medical board to issue such a requirement, which it did.

More laws to come?

Sherry Green, CEO of the National Alliance for Model State Drug Laws, said that in the 18 years she has been tracking these laws, this is the first time she has seen so many states pass such broad requirements, all within a year. “It’s highly unusual,” she said. And likely indicative of what’s to come.

“I would have to say that based on what’s happened this year, we definitely might be seeing a trend,” she said. Green expects that some of the states that considered including these requirements in the past, but didn’t think they had enough support to get them through, may build on the momentum and “see this as a door to move forward.”

Both the Tennessee Medical Assn. and the Medical Society of the State of New York had input into the laws in their respective states.

Zelizer said the law in Tennessee was narrowed a little from its original language, which called for a check of the database every time a controlled substance is initially prescribed and every six months after that. It was changed to require a check of the database for an initial opioid or benzodiazepines prescription and annually after that. Exceptions also were written in for postoperative prescriptions, those with a seven-day or less supply with no refills, and those written for hospice patients.

The TMA also successfully argued to allow physicians to have another staff person with log-in credentials to check the database on the physician’s behalf. New York was able to get a similar provision in its law, but “it was extremely difficult to get,” said MSSNY President Robert Hughes, MD.

Dr. Hughes said legislators are placing too much of the blame on physicians for the prescription drug abuse problem. He said that although he doesn’t deny there are doctors writing too many prescriptions, and patients doctor-shopping, “there’s a lot of other people responsible for the problem.” The state could have implemented other programs such as public education campaigns alerting the pubic to the dangers of leaving prescription drugs laying around the house, he said.

According to the Prescription Monitoring Program Training and Technical Assistance at Brandeis University in Waltham, Mass., there’s never been a formal evaluation of the impact these laws have had on either the prescription drug epidemic or the availability of prescriptions to legitimate patients.

In most states, pharmacists are responsible for sending the prescription information to the state database, though if doctors are the dispensers, they are responsible for sharing that information. Database updates can vary, from every 30 days, to every seven days in Kentucky, to real-time updates in New York.

In 2010, the latest information available, about 12 million Americans age 12 and older took prescription pain medications for nonmedical reasons, according to the Centers for Disease Control and Prevention. In 2008, opioid prescription painkillers were involved in 14,800 drug overdose deaths, up from 4,000 in 1999, the CDC said.

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