A bad idea is back

March 21, 1994

Four years ago, the General Assembly put to rest a bad idea, but this session it's back. Two bills propose some kind of system for monitoring prescriptions for morphine and other pain-killing drugs that have a high potential for abuse. The classic version, reflected in a Senate bill, is "trip-scrip," a triplicate prescription form intended to help authorities prevent physicians from creating addicts or diverting drugs to illegal channels.

There's just one problem: the system doesn't accomplish that goal, and it carries some painful liabilities. As one Hopkins physician testified before a Senate committee this week, most physicians will go to extraordinary lengths to avoid the prospect of having to answer questions from federal drug enforcement agents. The result in other states that have adopted trip-scrip plans has been a drop in prescriptions for pain-controlling medications. But only a couple of weeks ago, the federal government released long-awaited guidelines addressing the opposite problem -- the critical need for physicians to prescribe more opiates to relieve pain in cancer patients.

Another telling sign of problems with trip-scrip is the fact that several states that adopted the system are having second thoughts. Last summer, Indiana allowed its program to expire. Legislators in that state did not consider the system a cost-effective means of reducing drug diversions and abuse. To their credit, they were also concerned about the negative effects the program had on appropriate care of patients in pain.

A commission appointed to review California's trip-scrip plan, which has been in effect since the 1930s, concluded last year that the triplicate system was antiquated and ineffective. It recommended that the state move to an electronic monitoring system. That approach makes more sense.

In 1991, Gov. William Donald Schaefer's Prescription Drug Commission recommended against trip-scrip, while noting that the vast majority of pharmacies in Maryland are already computerized. If some form of prescription monitoring is necessary here -- and that is open to question -- an electronic system poses fewer problems.

Trip-scrip schemes may cause temporary shortages in illicit street trade, but illegal labs soon fill the gap. Meanwhile, the sinister effect of trip-scrip hurts patients who have a legitimate need for these drugs.

Given what we now know about the differences between pain relief and addiction, it would be unconscionable for legislators to confuse illegal drug abuse with humane medical care.

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