State office to monitor prescriptions New program to give doctors heads-up on suspected abuse

In an effort to identify abusers of narcotic pain relievers and other drugs, the state’s Office of Substance Abuse this month will begin collecting detailed prescription data from every pharmacy in Maine. The information will be compiled twice a month and searched for evidence of “doctor shopping,” the practice employed by many drug users to obtain multiple prescriptions from different prescribers.

The database will track purchases of “scheduled” drugs – those with potential for abuse, such as painkillers, tranquilizers and antidepressants. When multiple purchases by the same person, too frequent refills and other suspicious patterns are identified, the prescribing physician or physicians will be alerted and encouraged to review the patient’s needs, adjust prescriptions accordingly and refer the patient for substance abuse counseling if appropriate.

Physicians also may request information about their patients in order to determine their drug-buying behaviors before prescribing new medications or renewing existing prescriptions.

In establishing the electronic Prescription Monitoring Program, Maine becomes one of several states to keep track of drug purchases, and one of the very few that do not intend the system to be used for purposes of law enforcement.

“The PMP’s goal is to create a tool that may improve community care and reduce addiction and overdose by stressing prevention and treatment,” according to a release from the Office of Substance Abuse. The program is intended to promote public health and welfare, said OSA director Kim Johnson, and not to be used as a legal tool.

“Law enforcement [officials] will be able to subpoena specific information for a case they are already investigating,” Johnson said. “But they can’t go on a fishing expedition.”

Allowable access to the information contained in the database is strictly outlined in the 2003 legislation that mandated its creation. Prescribers and pharmacists may request information on specific individuals. With supervision and proof of identification, consumers will be able to see their own records. Select OSA staff and data managers from the company chosen to administer the program will have direct access.

Unauthorized access to or release of the information for purposes other than its intended use constitutes a felony, punishable by up to five years in prison, according to Assistant Attorney General James Cameron. Physicians and other prescribers are protected from legal consequences and free to communicate concerns about their patients to law enforcement officials, he said.

“But in most cases, it’s not appropriate,” he added. “Addiction is a disease that needs treatment.”

Cameron said the Attorney General’s Office has been closely involved with the planning and design of the PMP with a goal of ensuring the security of the information it contains. “Right now, it’s about as secure as information in a doctor’s office,” he said.

Cameron said Maine officials looked at similar programs in several other states when designing Maine’s PMP, and used a program in Kentucky as a model.

Robert Kelley, supervisor of investigations for the Kentucky Drug Enforcement Agency, said Friday afternoon that the Kentucky All-Schedule Prescription Electronic Register has been “wonderful.” Without having specific statistics, Kelley said KASPER, in place since 1999, is used extensively by prescribers, law enforcement officials and licensing boards. As in Maine, Kentucky law enforcement officials can access an individual’s KASPER report only if that person is involved in a current investigation, he said.

“I couldn’t begin to tell you how much this has saved us in terms of money, trouble and man-hours,” he said. Kentucky still has a significant problem with prescription drug abuse, Kelley said, but KASPER provides a “road map” of where the trouble spots are. The program has six full-time dedicated staff and generates 500 to 600 reports a day, most requested by physicians monitoring their patients’ drug use. The program is especially popular with doctors who specialize in pain management, many of whom run routine monthly checks on their patients, according to Kelley.

Drug abusers from Kentucky sometimes fill prescriptions in neighboring states to avoid the monitoring system, but at least three of those states are developing drug monitoring systems of their own, Kelley said. “At some point, we’d like to get our databases coordinated [with the other states], but that’s just an idea right now,” he said.

Maine’s PMP is funded with a $300,000 grant from the federal Department of Justice, which has paid for developing the program, providing training and support, and hiring one full-time staff person. OSA’s Kim Johnson said ongoing funding might be available through more federal grants. If not, she’ll have to find the money within her already tight budget.

Maine’s program will start collecting data for July at the end of the month, giving pharmacists a little leeway in getting their reporting software adapted. After that, pharmacists will submit information every two weeks. The state will spend several months troubleshooting the program before making information available to doctors beginning in October.