Montana is one of about eight states that do not have such a database, called a Prescription Drug Monitoring Program. The program was proposed during the 2007 Legislature, but died in committee. The Department of Justice has since invested $50,000 into drawing a blueprint for the database, and legislation will again be proposed when the 2009 Legislature convenes. By most accounts, it will be a shoo-in.
“The major benefits would be for physicians and practitioners who could see what controlled substances have already been dispensed to patients,” said Ronald Klein, executive director of the Montana Board of Pharmacy. “That's an enormous aid in evaluating and treating a patient.”
Today, Montana teenagers report using prescription drugs more than any other substance, he said, and resources like the drug monitoring plan could go a long way toward getting a handle on the problem.
“We're behind the curve on it,” Long said. “Until now, we have done very little about people selling and abusing prescription drugs like painkillers.”
Addicts acquire prescription drugs by stealing them, faking injuries, getting legitimate prescriptions or by visiting multiple physicians for the same injury, a scheme known as “doctor shopping.”
Most of the drugs are powerful narcotic painkillers such as oxycodone, fentanyl, methadone, morphine and hydrocodone. The Drug Enforcement Administration has designated Billings a crisis zone for abuse of fentanyl and morphine, and studies show the city ranks second in the nation per capita for reported abuse of fentanyl, an opioid with a potency about 81 times that of morphine.
Right now, Long said, doctors and pharmacists in Montana have no idea if a patient complaining of pain is getting prescriptions all over town and then selling those pills to other addicts, a lucrative business that is rapidly growing as people realize the addictive potential of narcotic opiates. Brand-name drugs such as OxyContin, a time-release version of the generic drug oxycodone, sell for roughly a buck a milligram on the street.
But critics say the database could have unintended consequences, creating an adverse chilling effect on patients whose legitimate chronic pain issues and excruciating terminal illnesses require tremendous amounts of opiates. That patient population is already having trouble obtaining the drugs they need because doctors fear they'll be targeted by DEA investigations.
“I can't think of a single physician who's not going to say, ‘Yes, I want that.' But when it gives law enforcement all kinds of opportunities to go on fishing expeditions, it is not in the best interests of our patients,” said Dr. Randale Sechrest, medical director of the Montana Spine and Pain Center at St. Patrick Hospital in Missoula.
In the past six years, Sechrest has seen a 30 percent to 40 percent decrease in the number of physicians willing to treat chronic pain in Missoula.
Long said the database would not be readily available to law enforcement and would only cover certain drugs to protect Montanans' privacy.
Pharmacy board officials vaunting the database's potential said the resource would allow doctors to make judgments and prescribe medicine without fear, which also could compromise patient care. The database could be examined by police as part of an active investigation, but authorities couldn't use it to ply the state's doctors, who could be criminally prosecuted for overprescribing narcotic painkillers.
“In fact, just the opposite would occur,” said Klein, at the Montana Board of Pharmacy. “Pain management specialists would be more comfortable prescribing controlled substances, including narcotics, because they would know whether a patient is faking it or not. This would not enable law enforcement to go on the proverbial fishing expedition.”
“It's a patient safety initiative, not a law enforcement initiative,” Klein said. “It is designed to help the practitioner and the pharmacist see if there's a problem with the therapy of a patient, to determine what other drugs they are taking.”
But Sechrest thinks law enforcement should be excluded from the plan entirely, saying privacy issues are too important to his patients' therapy to be compromised.
“Once the data exists, you've lost all control of it,” he said.
During a presentation before the 2007 Legislature, then-Board of Pharmacy executive director Starla Blank said prescribers, dispensers, patients, licensing boards and law enforcement could request a confidential report from the database. The report would list all scheduled prescriptions filled for a patient during a specified time period, including the prescriber and the pharmacy.
Blank said the database is intended to be a source of information for practitioners and pharmacists to use in the care of patients, as well as a tool for law enforcement to help deter drug abuse and diversion.
Still, she said, the prescription drug monitoring program is not intended to prevent patients from obtaining needed drugs.
Twenty-four states currently have prescription drug monitoring programs in place, while nine have enacted legislation enabling such programs. Three other states - New Jersey, Oregon and Montana - have legislation pending.
According to data provided by the Idaho Board of Pharmacy, 90 percent of the people accessing the database for profile requests are prescribing physicians, 5 percent are pharmacists and 3 percent are law enforcement. The other 2 percent are split evenly between licensing boards, patients and Medicaid.
If approved in Montana, the database would be housed under the state Board of Pharmacy, and anyone with prescribing authority could sign up, receive a user number and security password, and access the system to see what controlled substances have been dispensed to a patient. Pharmacists could use the database to look for any overlapping drug therapies.
If a pharmacist suspects someone is doubling up on prescriptions, Klein said, they could identify and call that person's physician, instead of relying on inadequate “phone trees.”
“This would essentially eliminate the problem of doctor shopping,” Klein said.
“Currently, doctors merely have access to what is in their records,” he said. “They can contact other physicians or call a pharmacy, but if a patient doesn't tell them, they can't do anything but make blind phone calls.”
Steve Bullock, the Democratic nominee for attorney general, has made prescription drug abuse one of the central issues of his campaign, and recently unveiled a plan to attack the problem based primarily on information from Long and Klein.
Bullock said he's most interested in joining the 35 other states that have established centralized prescription drug monitoring programs. He also proposed coordinating social resources and ramping up enforcement by making it illegal to “doctor shop,” and increasing public awareness of the dangers of and accessibility to powerful prescription narcotics.
“Working together with schools, parents, law enforcement and the medical community, we can curb this unnecessary loss of life and reverse the trend before it gets any worse,” Bullock said.
Reporter Tristan Scott can be reached at 523-5264 or at tscott@missoulian.com.
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