Pubdate: Tue, 09 Sep 2014 Source: Baltimore Sun (MD) Copyright: 2014 The Baltimore Sun Company Contact: http://www.baltimoresun.com/ Details: http://www.mapinc.org/media/37 Author: Meredith Cohn Page: 1 MD. TRACKS PAIN PILLS TO REDUCE OVERDOSES Prescription Monitoring Program Is Intended to Curtail 'Doctor Shopping' "We want to use data to drive people to treatment and services." Dr. Laura Herrera of the state health department 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-old pregnant woman to help, for example. "There are instances where I say, 'Wow, this is really good,'" he said. "Other times I say, 'Why isn't the information here?' About a third of the time, information is missing, and I want to be more confident in what I'm looking at." Technical problems are being worked out, according to the nonprofit that runs the system, the Columbia-based Chesapeake Regional Information System for our Patients, or CRISP, which embedded the program in the state's larger health information database. That's an electronic system created in 2009 but more extensively used in the last year by hospitals and doctors' offices to see patient emergency room visits, images and lab work even if they were done in other facilities. Eventually, the drug monitoring system will be able to handle more users and queries, said David Horrocks, CRISP's president. And it could do more sophisticated things such as alerting doctors to potential problems with a patient, something done in other states but not authorized by lawmakers in Maryland. He said the combination system is likely to continue drawing health professionals to sign up and keep using it because "If they had to go to two different places they would be less likely to do either thing." Part of the push to reduce overdose deaths involves reducing the number of prescriptions for legitimate purposes: Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for each American to have a bottle of pills, according to the U.S. Centers for Disease Control and Prevention and the Prescription Drug Monitoring Program Center of Excellence at Brandeis University. Maryland doctors wrote 74 prescriptions per 100 people, the data shows. CDC data also shows there were more than 15,500 overdose deaths related to opioid painkillers nationally in 2009, and more than 40 percent of overdose deaths in Maryland between 2007 and 2012 were linked to prescription pain pills. Some consumer advocates such as the Consumers Union have called on the Food and Drug Administration to make the drugs safer and asked that doctors look for alternative treatments for short-term pain associated with broken bones, for example. The monitoring programs have been shown to reduce those prescriptions. For example, the number of patients who visited multiple doctors for the same drugs dropped 75 percent in New York after prescribers were required to check the system in 2012. In Tennessee, the number of patients who doctor-shopped dropped by a third in 2013 after prescribers began checking. Kentucky officials say that their monitoring program processes more than 20,000 requests for prescription information a day from prescribers checking on patients, close to one a day from each of the 25,000 people registered to use the system. Still, last year, data showed there were more deaths linked to prescription drugs than illicit drugs. - --- MAP posted-by: Jay Bergstrom