State hopes tracking pain pills will reduce overdoses

Maryland lagged other states in creating prescription drug monitoring program to stop 'doctor shopping'

September 08, 2014|Meredith Cohn, The Baltimore Sun

A database in Kentucky that has tracked potentially dangerous and addictive prescriptions dispensed in the state for the past 15 years has become a national model by helping significantly reduce so-called doctor-shopping for pain drugs.

Federal data show the state has dropped from the second-highest abuser of prescription drugs such as OxyContin and Percocet to 31st.

But what it and other states cannot show is that such programs cut down on overdose deaths from all legal and illegal drugs, a lesson not lost on Maryland as its joins every other state in launching its own prescription drug monitoring system. Maryland hopes to succeed where others may have failed, and Gov. Martin O'Malley even set a goal of reducing overdose deaths by 20 percent by the end of 2015.

"We want to use data to drive people to treatment and services, while in other states the programs sit in law enforcement or pharmacy boards," said Dr. Laura Herrera, the health department's deputy secretary of public health services. "We think this has huge potential."

Maryland became one of the last states to launch a prescription drug monitoring program when it began in December. The system still is registering users and working the kinks out, but officials and observers believe there are some important differences. The program is overseen by the health department with the aim of steering abusers to treatment, seeing larger prescribing trends and even heading off abuse.

But drug abusers can be very hard to deter.

"A user is a user and will use whatever is there," said Linda Simoni-Wastila, a professor in the University of Maryland's School of Pharmacy, who studies prescription drug policy and programs. "They are now going from opioids to heroin."

Just making it harder to get pills won't solve the overdose problem, Simoni-Wastila said.

Abusers will go to other states with looser rules for prescription drugs because the drug monitoring programs are not yet linked. Or they will find unscrupulous pain doctors — federal authorities recently indicted a Rockville doctor on charges of running a so-called "pill mill" that lead to a patient's death. Meanwhile heroin is cheap and readily available, she added.

It's unknown how many Maryland pharmacies and doctors will sign up through the program's website and routinely check their patients' drug histories. Only pharmacies and other dispensers were required by the 2011 law, not those who prescribe drugs.

The system now is adding about 150 doctors and pharmacists and others a week. About 4,500 accounts have been created, with about a third from pharmacies and the rest from doctors, dentists, registered nurses and others who can prescribe drugs, according to Michael Baier, program coordinator at the state health department's Alcohol and Drug Abuse Administration.

That accounts for a large portion of the pharmacies but a smaller share of doctors and other prescribers. There are about 14,000 to 16,000 practicing physicians in Maryland, according to MedChi, the state's medical society, and Baier said officials have enlisted the group and others to spread information about the program and how to steer addicts to services.

Doctors watch a video on safe prescribing when they create an account and other continuing education courses are being explored, some that may become mandatory, state health officials said.

The system was being checked about 5,200 times a week in February and more than 12,000 times a week by mid-August. Baier said some have been surprised by some of their patients' histories.

Officials want more doctors to sign up and use the system and are targeting those who work in emergency departments and pain clinics, where many abusers shop.

"We have a long way to go to where everyone who should be using it is using it," Baier said. "We're prioritizing."

He doesn't expect all doctors to sign up to use the system, which the state is spending almost $1.5 million of mostly federal funds to develop and run for the first three years. If too many doctors register at once, it may need even more resources.

The system already may be strained, according to Dr. Michael Fingerhood, an addiction specialist and an associate professor at the Johns Hopkins University, who was frustrated the state was years behind almost all others in developing a system.

Several new patients told him they had shopped in emergency departments for prescriptions, but nothing was recorded in the system. One patient had been entered into the system in eight separate accounts. The system can be slow, or down altogether, and requires many clicks to see all the pills dispensed to a particular patient.

Difficulties aside, he believes Maryland's approach could help reduce overdose deaths. He's already used information from the system to steer a 23-year pregnant woman to help, for example.

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