Pubdate: Mon, 19 Aug 2002
Source: Charlotte Observer (NC)
Copyright: 2002 The Charlotte Observer
Contact:  http://www.charlotte.com/mld/observer/
Details: http://www.mapinc.org/media/78
Author: Cristina C. Breen

CAROLINAS CONSIDER MONITORS FOR DRUGS

OxyContin Abuse Prompts Both States To Seek Closer Scrutiny

Several N.C. lawmakers and the head of the N.C. Department of Health and 
Human Services say the state needs a prescription drug monitoring program 
to reduce the abuse of prescription drugs such as OxyContin.

Lawmakers in both North Carolina and South Carolina say they're interested 
in starting a program. Such programs are helping reduce prescription drug 
abuse in some other states. But Carolinas officials say they're hesitant to 
start any new initiatives during a year when they're cutting jobs and 
programs to balance a $1.5 billion revenue shortfall.

N.C. Secretary of Health and Human Services Carmen Hooker Odom said she's 
examining how to set up a monitoring program. But, she said, "The question 
is, does the General Assembly say this is a top priority and will it 
mandate that you do it and give you the money, or not give you the money?"

Seventeen states use a computer database to flag patients who visit 
different doctors or pharmacies for the same drug, or get suspicious 
amounts of it.

"There should be ... a system that's in place that can trigger bells and 
whistles and red flags when there seems to be an inappropriate use of a 
drug," said Sen. Fountain Odom, D-Mecklenburg, who is married to Hooker 
Odom. But he said a proposal for a program launched during the budget 
crisis would be shot down because of the state's rocky finances.

S.C. Attorney General Charlie Condon said he is looking into getting 
federal money to start a program. The soonest a bill could be introduced in 
either state is January, when both legislatures return.

A program could cost the states little or nothing to start, because the 
U.S. Department of Justice has pledged a total of $2 million in grants to 
help set up programs. But N.C. lawmakers say they're worried about 
maintaining it. It's unclear how much a program would cost, because the 
price would depend on several factors, including how much technology the 
system would use and whether new staff would be needed to run it.

A Charlotte Observer investigation published in July found that OxyContin 
abuse may have caused or contributed to at least 97 overdose deaths in the 
Carolinas in 2000 and 2001. In most cases, other drugs or alcohol may have 
been involved.

OxyContin, introduced in 1996, is an effective drug for patients with 
severe pain because it provides long-lasting, powerful relief without 
negative side effects, unlike other prescription narcotics. But abusers 
discovered that crushing the tablets disables the drug's patented 
time-release formula, releasing 12 hours of narcotic at once.

Law enforcement and the medical community have faced the challenge of how 
to crack down on abuse of OxyContin without limiting the supply of the drug 
to those who need it.

N.C. Reps. Dan Blue and Robert Hensley proposed starting a monitoring 
system last year, but the measure died before coming to a vote in the 
General Assembly. Hensley said it failed because of some lawmakers' 
concerns that a program would unfairly burden small pharmacies that don't 
have enough workers to keep track of patients' records and report them to 
the state.

"The impetus for it was the OxyContin problem," Hensley said.

Bill Purcell, a doctor who chairs the N.C. Senate Health Committee, is 
concerned about rapidly increasing health-care costs and says a monitoring 
program could keep Medicaid costs down by catching abusers.

North Carolina's Medicaid program is already tackling the expensive problem 
of prescription drug abuse by Medicaid patients. Since March, doctors must 
get permission from the state before prescribing OxyContin and other widely 
abused drugs to a Medicaid patient. The number of OxyContin prescriptions 
paid for by Medicaid has dropped 30 percent.

The maker of OxyContin, Conn.-based Purdue Pharma, supports a prescription 
drug monitoring program. It has successfully lobbied for the program in 
other states in recent years.

Purdue's senior medical director, J. David Haddox, suggests a program:

. Be administered by state health officials instead of law enforcement.

. Monitor all controlled drugs.

. Take pains to protect patient confidentiality.

. Allow law enforcement officials access only if they have the name of a 
specific person they're investigating.

Critics say the responsibility to update the system would fall on busy 
pharmacists, and would be impossible for small pharmacies with small staffs 
and little technology.

"Mom and pop operations struggle as it is ... and, ultimately, they're the 
ones who are going to be responsible," said Rep. Wilma Sherrill, 
R-Buncombe, who has spoken out against a prescription monitoring program.

Hensley and other proponents argue that all pharmacies have access to 
computers and it would not require much time or resources to contribute 
information for a monitoring system.

In South Carolina, Rep. Tracy Edge, R-Horry, said cutting down on fake 
Medicaid claims is a powerful argument: "Number one, it would help with 
fraud at the state level. Number two, it would save people who would 
otherwise get addicted."

But S.C. Rep. Joe Brown, chairman of the Medical, Military, Public and 
Municipal Affairs committee, said he's heard no talk of it among other 
lawmakers.

"I definitely think it'd be worthwhile, but I haven't given much thought to 
it," Brown said.

In March, U.S. Drug Enforcement Administration head Asa Hutchinson asked 
state attorneys general to consider starting prescription monitoring 
programs in their states.

Condon, the S.C. attorney general, said he's looking for ways to start a 
monitoring program through the state's Department of Health and 
Environmental Control.

"State governments need to have in place long-range plans to deal with 
problems" relating to the abuse of prescription drugs, Condon said.

Loy Ingold, special agent in charge of the N.C. State Bureau of 
Investigation's statewide diversion and environmental crimes unit, said a 
prescription monitoring program "is much needed in North Carolina," because 
it would limit the illegal prescription drug trade and help physicians root 
out patients who are duping them.

Ingold said his division would take initiative in applying for grants to 
start up a program, if lawmakers would support it by passing legislation 
creating a program.

Nevada health officials started a program five years ago that has been 
touted as one of the nation's best.

Doctors and pharmacists who want information about a patient can fax a 
signed letter to the board of pharmacy and days later they are mailed a 
list of the doctors the patient has seen and prescriptions the patient 
received.

Then it's up to doctors to take action if a patient appears to be "doctor 
shopping" by going to many different doctors seeking the same drugs, or 
bouncing from pharmacy to pharmacy seeking the same prescription.

Nevada's system also works in another way.

If a patient sees more than 10 doctors, 10 pharmacies, or gets more than 
600 doses of a medication (usually pills) in 60 days, the computer system 
sends out an alert.

Five years ago, the drug buyers flagged by the computer system filled an 
average of 159 prescriptions in 12 months, saw 22 doctors and bought 9,351 
pills.

Last year, drug buyers flagged by the monitoring system filled an average 
of 54 prescriptions, saw 12 doctors and bought 3,000 pills, indicating that 
authorities are able to find violators quicker, before they visit more 
doctors and get more pills.

Keith MacDonald, executive secretary to the Nevada State Board of Pharmacy, 
said the population that benefits the most from the program is "the doctors 
and pharmacists who are being pestered by these people."

Once doctors know patients are abusing the system, "they can cut it off 
right away and not be failed or duped by them," MacDonald said.
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MAP posted-by: Larry Stevens