MAINE FOCUS

Prescription tracking at 10: Why it still has much to prove, but could be Maine’s best weapon against drug abuse

Posted July 25, 2014, at 2:13 p.m.
Last modified July 28, 2014, at 5:56 a.m.

Part 1 of a 2-part series

Anne Perry offered her longtime patient a choice.

The patient was prescribed painkillers for chronic pain. She also complained of anxiety and asked for benzodiazepines, an addictive class of medications that includes Xanax and Valium, which opiate abusers often take to enhance their high.

Perry wouldn’t prescribe “benzos,” opting for a less addictive medication instead. But when she later typed her patient’s name into Maine’s prescription drug monitoring program, a database of controlled drug transactions, she learned the woman obtained the potent anxiety medication from another local doctor shortly after Perry turned her down.

As a nurse practitioner in Calais, Perry bore witness to the dawn of Maine’s prescription drug abuse epidemic. In 2000, the powerful narcotic painkiller OxyContin was first identified as a public health threat in Washington County, heralding a new era of addiction that Maine is still struggling to stem.

Two years later, as a freshman legislator, Perry sponsored the founding legislation for the prescription monitoring program in the first bill she ever submitted. The program, launched in July 2004, turns 10 years old this month.

At the time, Maine envisioned the potential to identify patients who “doctor shop” — visiting multiple medical practices to score narcotics and other drugs — and prevent the diversion and abuse of painkillers.

Today, 49 states ( all but Missouri) have enacted legislation to set up prescription drug monitoring systems.

Maine’s prescription monitoring program helped Perry give her patient a simple choice: Pick who you want to treat you, the other doctor or me. The woman kept trying to see both providers. Perry ended up losing a patient.

“She went to the doctor to get what she wanted,” Perry, who’s now running for the Maine Senate, recalls. “I made the choice for her.”

‘Like it was popcorn’

With opiate addiction reaching new crisis levels in New England, five governors met in June to call for better tracking of prescriptions across state borders as the key to a renewed regional strategy against drug abuse. ( Maine Gov. Paul LePage was not among them.)

Yet after 10 years of monitoring in Maine, the program still has much to achieve against the drug abuse and pill diversion problem it was established to combat. In fact, prescription drug abuse worsened in the state over most of its existence.

Drug overdoses killed 176 people in Maine last year, with prescription opiates cited as the cause in 105 of those deaths. Since 2002, Maine’s annual death toll from drugs has never fallen below 153.

Nearly 1,000 Maine babies — accounting for 7 percent of all births — were born exposed to drugs last year. One in 10 Maine high school students report misusing a prescription drug during their lifetime.

The prescription painkiller epidemic has its roots in the late 1990s, when influential medical organizations began encouraging doctors to consider pain as a measurable symptom to document and treat. Around the same time, potent new painkillers such as OxyContin were hitting the market.

Many doctors began prescribing the powerful narcotics more frequently, without anticipating the wave of opiate addiction that later occurred.

“We started handing this stuff out like it was popcorn, and that was really the beginning of this whole problem,” says Kurt Johnston, chief of pharmacy services for the VA Maine Health Care System.

A program with problems

Maine and other states struggled to address escalating abuse, leading to programs like the prescription monitoring program. The database tracks opioid painkillers, such as oxycodone and hydrocodone, tranquilizers, including benzodiazepines, and stimulants, which are controlled, or regulated, by the federal Drug Enforcement Administration because of their potential for abuse.

Yet until registration in the prescription monitoring program became mandatory earlier this year, only about 40 percent of Maine’s roughly 7,000 prescribers of controlled drugs — doctors, nurses and dentists, among others — participated in the program through May 2012, according to program assessments.

Many other states had even lower sign-up rates.

Some prescribers were frustrated by a clunky online interface that since has been improved, says Gordon Smith of the Maine Medical Association. Primary care doctors, who treat the bulk of chronic pain patients, signed up early, while providers who prescribe narcotics only occasionally were slower to enroll, he said.

Officials at first avoided mandating registration, hoping prescribers would sign up willingly as they became familiar with the program and its mission.

The state then attempted to encourage higher registration by allowing voluntary sign-ups provided 90 percent of practitioners participated as of Jan. 1. Not enough signed up, so registration became mandatory as of March.

Now more than 92 percent of Maine’s prescribers are enrolled. They’re also checking the database more often, with use up 30 percent, Smith says.

Maine’s program suffered from significant blind spots. Two of the state’s major drug providers — the VA system and methadone clinics — were barred from submitting information to the database because of federal regulations.

Health providers and pharmacists in the VA system can now view the data, says Johnston, but come September they expect to submit prescription information through a new national interface.

The VA shielded the data in many states because of federal limits on disclosing veterans’ health information until a law change in 2011.

The September update is a major milestone, as the VA system issues almost 10 percent of all prescriptions for controlled substances in Maine, according to Johnston, a staunch advocate for the addition of veteran data.

“It breaks my heart that we sit here and can’t help our colleagues in the community,” he says. “One of every 10 prescriptions is blinded to them.”

Methadone clinics similarly can view but not submit data to the system, which would violate federal confidentiality regulations on substance abuse treatment.

Despite these holes, observers believe Maine’s program, plus others like it, has prevented prescription drug abuse from claiming more lives.

“The biggest impact of Maine’s and other [monitoring] programs has been to slow down and to prevent the most rapid escalation of overdose and death and abuse involving the opioids,” says John Eadie, director of the Prescription Drug Monitoring Program Center of Excellence at Brandeis University.

A slate of new reforms to the program taking effect this year, along with increased understanding of opiate abuse and drug diversion by government agencies and medical professionals, also promise improved results for its next 10 years.

For Perry, who has been at the vanguard of prescription drug abuse as a nurse and lawmaker, it means the hard work must continue. Monitoring prescriptions, she says, remains one big part of the solution.

“It’s a tool to help us do better,” she says about the program. “But it certainly isn’t the answer to the drug problem.”

See Part 2: Maine police, doctors and lawmakers disagree on more stringent monitoring, even as drug abuse picture improves.

 

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