LINNEUS, Maine — A statewide program that helps Maine health care providers to identify patients who may be abusing or illegally distributing prescription drugs is at risk of being eliminated without new funding.
The Diversion Alert Program provides secure online access to drug arrest data to health care providers so they can identify patients at risk of overdosing, in need of addiction treatment or engaged in illegal prescription drug distribution.
The program initially was established in Aroostook County in 2009 before being expanded statewide in 2013 with funding from a two-year grant from the Maine attorney general’s office.
Clare Desrosiers, who runs the program out of her home in the southern Aroostook community of Linneus, said it tackles the underlying cause of prescription drug abuse — access to drugs through prescribers.
Besides alerting medical professionals about possible abuse and addiction problems, Desrosiers explained, the program also offers “educational material to assist in responding to these patients, so they can find out where they can go and what they can do to get help.”
Each month, the program distributes a list of individuals arrested or summoned for prescription or illegal drug-related crimes in each public health district to prescribers, pharmacists and law enforcement agencies registered to receive the alerts. Health care providers are not required to share patient information with law enforcement officials.
Desrosiers said the two-person operation has been run on a $95,000 annual budget.
“We really are a bare-bones operation anyway,” she said. “I work out of my home, and my colleague worked out of her home. We do not rent office space or have a huge staff.”
Desrosiers said she has submitted at least 10 grant applications in anticipation of funding for the two-year pilot project running out in February, but has had little success.
“It is a difficult time to apply. There is not a lot of money out there,” she said.
But because the other staffer is leaving and the program has been run on such a tight budget, Desrosiers said she has about $23,000 remaining and can keep going until June.
She said she could continue running the program herself on an annual budget of about $57,000 if she had to and would continue her fundraising efforts.
Desrosiers stressed that the Diversion Alert Program is different from Maine’s Prescription Monitoring Program, which is administered by the Office of Substance Abuse and Mental Health Services in the Maine Department of Health and Human Services. That program provides doctors, other prescribers and pharmacists medical information about all controlled substance prescriptions dispensed to patients in Maine through another online, password-protected database.
That system automatically notifies prescribers when patients engage in behaviors that could indicate misuse, such as visiting a high number of doctors and pharmacists over a three-month period. It does not, however, indicate when a patient has been charged with trying to buy or sell prescription medications.
The prescription monitoring program, however, deals with confidential patient information and is protected by federal patient privacy laws, Desrosiers said.
“So that information cannot be shared outside of your health care providers by someone like a law enforcement officer in an email or a printout,” she said.
Aroostook County Sheriff Darrell Crandall, who has been involved with the Diversion Alert Program since its development and now sits on the board of directors, said he supports the program and believes it is working.
“This has changed prescribing practices among doctors and other providers, which is what we had hoped for,” he said.
Crandall spent more than 20 years assigned to the Maine Drug Enforcement Agency, 12 of those years as a supervisor and eight as the division commander. He became involved with the Diversion Alert Program while working for the MDEA, just as the tide of prescription drug abuse began battering the state.
In 2013, 38 percent of arrests made by MDEA involved pharmaceuticals, according to statistics provided by the program. From 2008-2012, over 90 percent of overdose deaths in Maine were pharmaceutical-related.
“If the doctor looks at the diversion alert list and sees that the patient in the room with him has been arrested for selling OxyContin, he can look at the patient and say, ‘Hey I see you were arrested for selling this drug, and if you are selling it, do you really need it?’ I think such questions are ones that any responsible physician or prescriber would ask,” said Crandall.
For law enforcement agencies, Diversion Alert’s online database is the only system in Maine that links drug-related criminal charges statewide.
In a survey of the program conducted in 2013-14 by Dr. Elizabeth Depoy of Astos Evaluation, 84 percent of the 1,064 respondents reported “improved attentiveness to prescribing practices for all of their patients” as a result of Diversion Alert. Of that 84 percent, 81.7 percent were prescribers.
Desrosiers said Maine providers did not discharge patients who had been arrested, but rather continued to “provide well-informed and needed health care to all patients while also attending to alternative prescribing for those who have been involved in illegal substance activity.”
“I think this shows us that the program is effective,” she said. “It would be a shame to see this lose funding.”
Gordon Smith, executive vice president of the Maine Medical Association, agreed. At first, the doctors organization thought people might confuse Diversion Alert with Maine’s Prescription Monitoring Program, but that did not happen, he said Monday.
“Doctors have told me of the value of this program,” he said. “A busy physician may not see printed in the newspaper that a patient he or she prescribed a painkiller to a week ago was arrested shortly thereafter for a drug offense.”
He added that the increase in education provided by Diversion Alert also has helped to lower the impulse of physicians to simply drop a patient from their care when they see an arrest for a drug offense.
“We do not like to see physicians simply discharge patients,” said Smith. “That person may be in need of medical care. There are ways to sensitively and ethically deal with the issue. We see Diversion Alert as one more piece of information out there, and I do believe it is valuable for the particularly small amount of investment.”
Desrosiers fundraising efforts have not been without some success. Eastern Maine Healthcare Systems has pledged $5,000 to Diversion Alert if the program can raise an additional $30,000 by June 1, she said.
Sen. Michael Willette, R-Presque Isle, has submitted a bill, An Act To Enhance Substance Abuse Awareness, seeking $90,000 in state funding on behalf of the program. It would be enough for Desrosiers to replace her program assistant. She said Gov. Paul LePage has said that if the bill passes through the Legislature, he will not veto it.
Donations can be made via PayPal on the program’s website or can also be mailed to Diversion Alert, PO Box 1517, Houlton, ME 04730.