What if Maine had a computerized list of every painkiller prescription filled by pharmacies statewide?

And what if it could identify people who go to six or 10 doctors and get hundreds of oxycodone pills worth $40 each on the street?

And what if it allowed doctors and pharmacists to check each patient’s prescription history before writing and filling a new script?

Well, the list already exists.

Maine created the Prescription Monitoring Program in 2004 and is now one of 35 states that maintain such databases to help crack down on diversion — the illegal use of prescription pain medications to get high, feed an addiction or make money.

It’s considered to potentially be one of the most powerful tools to contain Maine’s abuse and addiction epidemic. But its effect has been limited because the state doesn’t have the resources to use the information more aggressively, and because it has had limited use by prescribers, pharmacies and law enforcement.

“They are going to be an essential tool as we go down the road,” said Dr. Leonard Paulozzi, a prescription drug abuse expert with the U.S. Centers for Disease Control and Prevention in Atlanta.

But, he said, “They have to be made full use of. They have to be adequately subsidized and adequately staffed, and the attitude has to be an aggressive one. They have to go after the problem instead of having people come to them with problems.”

Maine is in the middle of the pack among states that monitor prescriptions, according to a study by Paulozzi that was published in the journal Pain Medicine earlier this year.

The Maine Office of Substance Abuse uses the data to alert prescribers when patients go to too many doctors or pharmacies, while some states do not. But its reporting is more limited than that in the most aggressive states, including Kentucky and West Virginia.

Maine’s program tracks more than 2 million prescriptions a year for painkillers, as well as sedatives, tranquilizers, stimulants and other drugs with potential for abuse. About 40 percent of Maine residents receive at least one of the prescriptions and are therefore in the database.

The average patient in the database gets about four prescriptions in a year from one or two doctors, which would not raise red flags. But it’s not uncommon for some patients to get prescriptions from at least five doctors or pharmacists within just a few months. In 2008, one person got drugs from 61 prescribers, and four others went to at least 20 prescribers, according to state records.

Pharmacies send weekly dispensing reports into the database. There are some exceptions, including veterans health clinics and methadone clinics.

Because of the need to protect the privacy of health records, the database was set up with strict controls.

Prescribers and dispensers can look up only their own patients or customers. If they don’t like what they see, they can confront the patient and deny the drug. A recent law change allows medical office staffers to look up patients’ records for the doctors.

Law enforcement agencies cannot use the data to look for doctors who prescribe too freely or for “doctor shopping” by potential drug dealers. They need probable cause and a court order to look at the records of any individual.

Maine’s physicians, dentists and other prescribers have been gradually registering for the program on a voluntary basis, thanks in part to training and encouragement from groups such as the Maine Medical Association.

Seven years after the program’s launch, however, fewer than half of Maine’s doctors, dentists and other prescribers — 44 percent as of this summer — have registered to log on. And a smaller number actively uses it.

Only 29 percent of pharmacists have registered to check on patients when filling prescriptions, in part because some pharmacy chains do not allow external Internet use, according to state officials.

There also is no way to see when people get prescriptions outside the state.

A new state law opens the door to sharing prescription data with other states. But that won’t help much in the short run because it doesn’t include Maine’s two largest neighbors: Canada and New Hampshire, which doesn’t have a database.

Perhaps the biggest potential of the program is as a statewide monitoring tool.

A small number of states have staffs that watch the data and trends, and in some cases have legal authority to investigate individual patients or prescribers. The costs of such monitoring are outweighed by savings in Medicaid fraud, as well as health care and other addiction-related spending, Paulozzi said.

Maine’s program is coordinated by one staff member in the Office of Substance Abuse. With the help of computer software, she sent 5,662 alerts to prescribers in the last fiscal year because patients had exceeded the current threshold: five separate doctors or pharmacies.

State officials would like to issue reports sooner, perhaps when a patient goes to two or three doctors. But they can’t afford to do it.

“It becomes unmanageable because the numbers are so high,” said Guy Cousins, director of the Office of Substance Abuse. “It’s a question of having the staff to do it.’

Besides lacking staff to send more reports to doctors, the office has no staff to investigate the most suspicious prescription activity.  

Consider the individual who went to 61 prescribers in 2008. There is a possibility, at least, that the person was “doctor-shopping” and abusing or selling pills, or both.

The person’s name was not given to any drug enforcement agents for investigation, and there is no state review staff to determine whether the prescriptions were medically necessary. Instead, alerts were mailed to the physicians who prescribed the pills. It was left to them to decide whether to cut that patient off and, in effect, send him or her to another doctor.

MaineCare managers would have been notified if the public health insurance program covered any of the prescriptions, Cousins said. MaineCare does have staff investigators and can restrict patients who use too many doctors or pharmacies.

Experts say that even the most aggressive prescription tracking systems will not solve the whole problem. Doctor-shopping isn’t the only way the drugs get into the wrong hands.

But prescription tracking systems are a way to turn one of the biggest challenges of prescription drug abuse into an advantage, said Paulozzi, the CDC expert.

“It’s a unique way to track drug distribution (that) we don’t have for illegal drugs,” he said. “But we need to make better use of the data so it isn’t there simply when a doctor needs to look up a patient. I think it should be used more as a surveillance system.”

Staff Writer John Richardson can be contacted at 791-6324 or at: [email protected]


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