Pubdate: Sun, 14 Oct 2007
Source: State, The (SC)
Copyright: 2007 The State
Author: John Monk


The drug war in your medicine cabinet S.C. soon will start tracking
prescription drugs by computer.

Is this a blow against the black market or invasion of privacy?

The hunt for black market pushers and users of prescription drugs such
as OxyContin is going high tech.

As early as January, a new computer at the S.C. Department of Health
and Environmental Control will go online, linking the state's 1,225
independent and chain pharmacies.

 From then on, all pharmacies will upload to DHEC information on
everyone in South Carolina who buys painkillers, tranquilizers or
stimulants. This data includes the patient's name, date of birth,
address, kind of medication, dosage and the prescribing doctor.

Some say the new system smacks of =93Big Brother,=94 but law officers love
it because it will save them time.

=93With a few keystrokes, you can get the same information in 15 minutes
versus 15 days,=94 said John Ozaluk, the Drug Enforcement
Administration's chief in South Carolina. Currently, to check out a tip
that someone is illegally buying drugs at pharmacies, agents often
have to visit the store and inspect paper records, Ozaluk said. Agents
still will have to investigate cases and prove them in court, he said.

Many pill abusers -- it's unclear how many are out there =97 are =93docto
shoppers,=94 people who go from doctor to doctor, and pharmacy to
pharmacy, illegally amassing drugs to use or sell.

But pill abusers also include doctors, nurses and pharmacists who
steal, divert or overprescribe drugs, either for their own use or to
give to patients or friends.

This year, prescription-drug misuse has prompted state regulators to
discipline at least nine doctors, six pharmacists or pharmacy
technicians and 58 nurses. Discplined nurses were almost always
stealing drugs from hospital storage areas or medicines prescribed for
hospital and nursing-home patients, records show.


Law-enforcement officers are cheering the new system.

=93It's about time,=94 said Richland County Sheriff Leon Lott. =93This is
the forgotten drug war.=94

Currently, drug investigators get tips from a concerned relative,
friend or health-care worker. Or police might find pills on someone
they're arresting. Investigators then must visit each pharmacy to
inspect records.

Old-fashioned legwork, tips and snitches led to February's sentencing
of Lila Jones, 75, of West Columbia. Known as the Pill Lady, she had
for years sold prescription drugs in her neighborhood. She's now
serving three years in federal prison.

Beginning next year, DHEC's computer will show quickly if someone is
pharmacy-hopping, filing prescriptions from different doctors. It also
will show if a doctor or pharmacy is issuing unusual amounts of a drug.

According to the DEA, no breach of confidentiality ever has occurred
in programs similar to the one DHEC is setting up.

But libertarians and people with privacy concerns worry that so much
confidential data will be stored by one state agency.

=93Centralizing those records electronically in one government agency
creates too large a risk of unauthorized access to the deeply personal
medical information of thousands of law-abiding South Carolina
citizens,=94 wrote Gov. Mark Sanford in a June 2006 letter to the

That month, Sanford vetoed the bill that would have authorized the
program. The Legislature overrode him. But he has supporters.

=93It's Big Brother,=94 said Columbia defense attorney and former
prosecutor Joe McCulloch. =93It's government continuing its
ever-expanding appetite for the collection and organization of private
material that a few years ago would have been unthinkable.=94

McCulloch said it would be better if investigators had to show
=93probable cause=94 to a judge before accessing the information.

Columbians had mixed thoughts on the matter when asked last week
outside the CVS pharmacy on Assembly Street.

=93It sounds like the positives probably outweigh the negatives --
especially if there haven't been security issues in other states that
have it,=94 said Sarah Chakales, a USC senior majoring in broadcast

But Tom Baldwin, a financial analyst with the S.C. Department of
Insurance, said: =93I'm against it. I=92m kind of willing to give up some
freedoms for national security. But this would be one area where I
don't want it done.=94 He said the =93libertarian in me=94 doesn=92t want
give the state more personal information than necessary.


Eventually, the people with access to the information will number in
the thousands.

Besides a small contingent of drug officers at DHEC and DEA, potential
users of the system include the state's 4,313-plus pharmacists, the
thousands of doctors who prescribe controlled drugs and the state's
medical regulatory boards, according to the 2006 law.

Doctors and pharmacists will be considered a new line of defense.
Before they write or fill a prescription, they will be able to check
that someone who appears to need a prescription doesn't already have

=93Security measures will be in place, and access will be controlled,=94
Wilbur Harling, director of DHEC's drug-control bureau, wrote in an
e-mail to The State. =93... If anyone has a question or concern, we will
be happy to talk with them about it.=94

All users -- many of whom will access the system remotely, via the
Internet -- must be registered and use passwords. Different kinds of
users will have different levels of access. Audit trails will show any
improper use, according to state documents.

The software also will have spy-agency features.

For example, it can detect people who use variations of their names --
Jim Jones, J. Jones, James Jones -- to camouflage their identities as
they move from pharmacy to pharmacy.

Investigators said they are aware of how sensitive the data

=93Along with the responsibility of having access to that information
comes the responsibility of maintaining the integrity of that
information,=94 DEA's Ozaluk said.

Anyone breaching confidentiality will be charged with a felony and
subject to a $10,000 fine and 10 years in jail. Pharmacists, by law,
must participate.

=93If you knowingly fail to report, you are subject to a $2,000 fine,=94
Harling warned a gathering of pharmacists last month.

Many pharmacists don't yet know much about the system.

James Odom, a pharmacist at CVS' Assembly Street store near USC, said
he was unaware.

Lynn Connelly, who runs Medicine Mart on Sunset Boulevard in West
Columbia, said he knows a little but needs details.

DHEC said the agency has approved a training manual and expects to
mail it to pharmacists by the end of the month.

Overall, Connelly said, the changes are =93a good thing.=94

But he thinks the regulations impose extra duties without
compensation. =93It's another classic case of the government asking us
to do something else,=94 he said.


No one knows how much prescription-drug trafficking goes on in South

The DEA said it makes about 20 cases a year, but they are usually
larger, more complex cases, a spokesman said.

DHEC said the agency's 13 controlled-drug investigators make 400 to
500 cases a year. =93We have arrested physicians, pharmacists, nurses,
police officers. ... They run the gamut,=94 said spokesman Thom Berry.

According to DHEC, the DEA and SLED, South Carolina's most-abused
drugs include amphetamines, depressants such as Xanax and painkillers
such as Vicodin, OxyContin and Percocet.

Street prices per pill are mostly under $10, but a tab of Dilaudid, a
strong narcotic, can sell in the $60 range.

DHEC's computer will help target four major suspects: =93Doctor
shoppers,=94 young people who steal pills from friends or relatives,
health-care workers misusing drugs and =93pill mills=94 -- doctors or
pharmacies improperly churning out prescriptions.

Police may not be the new system's main users. =93We anticipate
physicians will be the biggest users,=94 DHEC's Harling told the
pharmacists' group last month.

That's the experience of Kentucky=92s 7-year-old KASPER system. South
Carolina's system is based on that one; 90 percent of its queries come
from doctors.

Kentucky's doctors, as a bonus, have found they can independently
check if patients are taking their medicine or not getting
prescriptions refilled, a KASPER spokesman said. Failure to take
medicines is a major problem, particularly among the elderly, studies

S.C. Medical Association president Dr. Gerald Harmon said he's looking
forward to doing quick checks via computer on his patients'

=93It can help our practices in many, many ways,=94 said Harmon, who still
has concerns about privacy. But the potential benefits are
significant, he said.


In recent years, about 25 other states have installed similar programs
with the help of federal drug-fighting grants.

A few S.C. lawmakers and DHEC's Harling pushed for a state law for
years while working with doctors and pharmacists, said Rep. Tracy
Edge, R-Horry.

Harling was instrumental in getting the $350,000 federal grant to buy
the system, said Edge, who co-sponsored the bill with former House
Speaker David Wilkins, R-Greenville. The money and Wilkins' clout
helped the bill pass and survive Sanford's veto.

Health Information Designs of Auburn, Ala., will set up the computer
and has a $635,000 contract to operate it through 2012.

The system does have a loophole -- perhaps an important one.

The many people buying drugs online, using online doctors and
pharmacies in other states, won't be entered in the system.
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