With prescription drug abuse on the rise, nearly every state has created a database that doctors and pharmacists can log in to if they want to check up on a patient who seems a little too eager for a bottle of Vicodin – but only about half of doctors are using them, according to a study published by researchers from Johns Hopkins University. These systems, called prescription drug monitoring programs, are supposed to help doctors identify “doctor shoppers” who go from office to office complaining of pain and then selling off their medication.
"This is an enormous problem. It is in fact an epidemic and it has really skyrocketed from 2000 to the present," says Steven Stack, president-elect of the American Medical Association and an emergency physician at St. Joseph East Lexington in Kentucky. "We have an incredible need to address this as a nation."
Each day, 46 people in the U.S. die from overdosing on prescription drugs, according to the Partnership for a Drug-Free New Jersey. A team of researchers from Johns Hopkins conducted the first nationwide study to examine doctors’ use of the programs aimed at preventing some of these deaths, and published their results on Monday in Health Affairs. The team asked 420 physicians if they were aware that their state offered such a program, and whether they used it.
The team found that about 72 percent of doctors knew that their state’s program existed, but only about half, or 53 percent, reported logging in. Nearly a fourth of doctors didn’t realize that their state offered a program in the first place – which the authors say may be due to the fact that a dozen states have only just introduced programs in the past three years. Stack agrees, saying, "This is a relatively recent phenomenon. The adoption and uptake of tools doesn't just happen overnight."
The researchers also tried to determine why some physicians who knew the databases were available had chosen not to use them. About 58 percent of doctors cited time constraints. Lainie Rutkow, a co-author and public policy researcher at Johns Hopkins, says states can help with this by allowing other staff members including nurses and physician’s assistants to log in and check prescriptions, as some already do. "It's still a little bit of a policy experiment," Rutkow says.
Another 28 percent of doctors said that their state’s systems were not easy enough to use. California’s database, known as Cures, is notoriously difficult. The program’s administrator testified to the state’s medical board last summer and said he is often kicked out of the system and fails to access its data on a regular basis, as reported by NBC San Diego.
Stack of the American Medical Association praises prescription drug monitoring programs and says he uses Kentucky's system every day in his work as an emergency physician. Still, he finds the program to be time-intensive and hard to navigate. "It's a useful tool," he says. "But every time I do it, I have to type in the patient's first name, last name, date of birth, Social Security number and street address."
Once a doctor makes it in, these databases typically contain records for medicines that are classified as controlled substances by the Drug Enforcement Administration, which means they have medicinal value but also a high potential for abuse. The National Institute on Drug Abuse reports that one in 143 patients who were prescribed an opioid painkiller in 2008 were potential doctor shoppers – accounting for 2 percent of all opioid prescriptions that year. The number of people who overdose on opioid pain relievers has quadrupled since 1999, according to the agency.
For doctors who knew that a prescription drug monitoring program was offered within their state, the vast majority – 98 percent -- found it to be at least somewhat useful and about three-fourths of physicians who used the programs said they had cut back on their opioid prescriptions as a result. A 2010 study of Ohio physicians found that 39 percent actually prescribed more opioids after using the prescription drug monitoring program, which Stack says is also a useful outcome in making sure that doctors prescribe medicines to patients who truly need them rather than holding back because of unfounded suspicions.
Rules about how doctors use the databases vary by state – New York and Tennessee require physicians to check them with every prescription for a qualifying drug, but doing so is optional in most states. Stack recommends against such requirements because he says they unnecessarily burden doctors, who should use their own professional judgment to decide when to run a check. Though he uses Kentucky's prescription drug monitoring program frequently, he points out that not every doctor is in a specialty that requires it.
In New Jersey, a bill recently was introduced to make doctors’ participation mandatory, but is opposed by the Medical Society of New Jersey on the grounds that physicians shouldn’t have to check the database unless they have a suspicion about a patient, as reported in a column by two members of the Partnership for a Drug-Free New Jersey.
Prescription drug monitoring programs also can identify clinicians who are perhaps prescribing dangerous medicines too casually. State medical licensing boards increasingly are gaining access to the programs and using their records to prompt investigations into the heaviest prescribers in their state.
There are only two states in the nation that do not have a database that health providers can access: Missouri's legislature is considering a bill that would instate one and Pennsylvania lawmakers signed a bill last year for a $1 million expansion that would make the system available to all health providers, but the state is struggling to fund it.
“I think we have a good product on the way once we get it up and running," says Scot Chadwick, legislative counsel at the Pennsylvania Medical Society, which advocated for the system and is also developing other measures meant to curb the state's prescription drug abuse. "The important thing is it's not in and of itself the complete answer. It has to be used in conjunction with the new prescribing guidelines and patient education and medicine drop-off programs.”