EDITORIALS

Until these changes are made, doctor shopping for painkillers will continue

Posted Aug. 05, 2014, at 11:07 a.m.
&quotI mean, oh my God, how could this be? How could this be? On the street, when the kids are using ... they're using, they're using. But this is a doctor. My son saw a doctor," Kelle Stavron said. Kelle and her husband, Bruce, lost their son, Matthew, to a prescription drug overdose. Matthew had been battling pill addiction for many years.
LIZ O. BAYLEN | MCT
"I mean, oh my God, how could this be? How could this be? On the street, when the kids are using ... they're using, they're using. But this is a doctor. My son saw a doctor," Kelle Stavron said. Kelle and her husband, Bruce, lost their son, Matthew, to a prescription drug overdose. Matthew had been battling pill addiction for many years.

There are many reasons to appreciate Maine’s prescription drug-monitoring program. It helps doctors and other prescribers know whether patients are “shopping” around at multiple medical practices to get addictive drugs; it helps cut down on the number of narcotics diverted for trafficking; and by pinpointing those who are abusing opioid painkillers, it helps physicians know who should be directed toward treatment.

As Jackie Farwell of the BDN highlighted in a recent two-part series, the drug-monitoring program has undergone many improvements over the 10 years of its existence. It’s no longer voluntary; anyone who prescribes controlled medications in Maine must register, so their prescriptions are recorded. Next year, pharmacies will update the database daily instead of weekly. And in September, for the first time, veterans’ prescription information will be searchable in Maine’s prescription database as the Department of Veterans Affairs begins contributing to the monitoring program.

These changes, and others, aim to improve the program’s basic functionality. It certainly hasn’t made sense all these years to omit veterans’ data, especially since the VA system issues nearly 10 percent of all prescriptions for controlled substances in Maine. And until registration was mandated for all prescription-writing providers earlier this year, only 40 percent of Maine’s 7,000 prescribers participated. The strength of the program depends on how many patients and prescribers it encompasses. To that end, there is work left to do.

Eventually all states should share their data, to crack down on doctor shopping across state lines. Maine, or the country, should also develop a data-sharing agreement with Canada, to reduce doctor shopping beyond the border. In addition, federal law allows methadone clinics to view patients’ information in drug monitoring systems but not submit it, creating a loophole that should be closed.

As policymakers address these gaps in the system, it’s essential that they keep physician usability foremost in mind. Physicians, physician assistants, dentists, podiatrists and advanced practice registered nurses are more likely to use the database if it’s easy to do so. They are busy enough without having to worry about a clunky digital interface.

For instance, many prescribers have found the password process cumbersome, as it requires a phone call to customer service when they forget it. Customer service representatives should be available on nights and weekends, or the log-in process should be improved to provide doctors with prompts when they forget their password.

In addition, instead of requiring physicians by law to check the database, as some have suggested, it would be helpful to develop a way for the system to automatically notify prescribers whenever patients’ behavior — getting two prescriptions from other doctors filled, for instance — raises red flags.

Providers can now sign up for regular email notices when patients receive a prescription from other prescribers or have their prescription dispensed at a pharmacy. But the notices are not immediate, and prescribers are not required to participate.

More than prevent illicit use, one of the monitoring program’s greatest strengths is that it can help identify who needs help. Doctors can then talk with patients about their addiction and connect them with the resources they need. Only by knowing about the problem can doctors try to direct patients toward treatment. The monitoring program is a valuable tool, and continued improvements will make it even more useful in the fight against opiate abuse and addiction.

 

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