Mass. can do better on prescription checks

Doctor group pushes for changes in bill

The US Centers for Disease Control, labeling prescription drug abuse the fastest growing drug problem in the nation, has suggested that “changes in state laws that focus on the prescribing practices of health-care providers might reduce prescription drug abuse and overdoses while still allowing safe and effective pain treatment.”

States are responding. Texas, which has made “doctor shopping” a felony, is moving information online, and activity is occurring in other states, including New York and Florida, the last of which is widely considered to be a center for “pill mills.”

And in perhaps what may be the most telling sign to date of the impact of prescription drug abuse on the nation, the American Academy of Pediatrics has issued a call for health professionals to step up their efforts to identify and treat drug-addicted newborns.

Massachusetts is acting as well, and while we’re ahead of the curve, we can do better.

The Legislature is about to pass legislation expanding the state’s Prescription Monitoring Program. The bill (Senate 2122, An Act Relative to Prescription Drug Diversion, Abuse and Addiction) would make physician participation in the Prescription Monitoring Program mandatory and force physicians to check into the program before prescribing any Schedule II or III drug to a patient.

The legislation has received mixed reviews. The Boston Herald has called it ‘astonishing micro-management’ and said “it opens the door to treating all physicians like unscrupulous Dr. Feelgoods while deputizing public health bureaucrats to keep it all in line,” while The Boston Globe, suggesting that doctors object to the bill because of  “inconvenience” and  “‘technophobia,” wrote that “paying even a bit of attention to the state prescription registry could save lives” and that “to stop addicts, doctors should register their prescriptions.”

Physician responses are also mixed. We at the Massachusetts Medical Society have supported the creation of the database on narcotics since it began in 1992, and we strongly support provider access to the database and consumer education on safe use, storage, and disposal of drugs. But we oppose the mandate to check the system before writing a prescription for a patient; that step could delay appropriate and timely care for patients. Why? The prescription monitoring program we now have isn’t being used to its best advantage. Nor are the goals of the program reflected in the legislative initiative.  

Since 1992, when the program was established (with financial support from physicians through their licensing fees), DPH has electronically recorded every prescription dispensed for Schedule II drugs, and since 2010, Schedule III through V as well. (These are drugs regulated by federal law based on their medical use and potential for abuse and dependence. Along with opioids and other powerful painkillers, they include mental health medications, prescription cough medicines, and minor pain relievers.) The goal of creating the database was to identify prescription drug abuse problems by monitoring patterns of abuse and diversion by pharmacies, prescribers, and individuals seeking drugs.

After 20 years and millions of dollars in fees, however, those goals seemingly have not been achieved. Here are some suggestions for improvement:

Eliminate cumbersome sign-up and access procedures for physicians that serve to dissuade prescriber use of the program. Give physicians automatic access to the Prescription Monitoring Program database. We are already registered with DPH, the Federal Drug Enforcement Administration, and the state Board of Registration in Medicine as prescribers. Additional registration is unnecessary.

• Ensure that the information in the Prescription Monitoring Program is accurate and timely by requiring real-time data. Currently, pharmacies have up to 10 days to report prescriptions to DPH, too long to stop drug-seeking behavior. Lag times are as long as three weeks in processing data.



• Require DPH to engage in meaningful analysis of its data, such as cross referencing prescribers and dispensers with reported drug overdoses to look for patterns of abuse leading to addiction and death. No such meaningful data has been released in the 20 years since the Prescription Monitoring Program was established.



• Require DPH to alert prescribers of real or suspected “doctor shoppers.”According to its own reports, the Prescription Monitoring Program identified over 11,000 patients as exhibiting “questionable behavior” but sent out reports on only 25 patients in 2011.

An electronic database is a strong tool in the fight against prescription drug abuse, and the DPH can and should be more proactive in the battle. Before the state adds more administrative and costly steps for  every individual prescriber, and before we take any steps that could delay or deny appropriate care to patients who need it, let’s recognize we have an adequate financial and legal framework in place to address this serious and growing public health epidemic. Let’s get the prescription monitoring program working as best we can.

Lynda Young, M.D., a Worcester pediatrician, is 2011-2012 President of the Massachusetts Medical Society