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Prescription Drug Monitoring: Is it Time to Add this Arrow to the New Hampshire Physician's Quiver?

Written by: Charla Bizios Stevens

The New Hampshire State Senate on March 21, 2012 passed SB 286, the Controlled Drug Health and Safety Act (the “Act”), which permits the electronic tracking of certain controlled prescription drugs with the potential for abuse.  These drugs include painkillers, tranquilizers and stimulants. The bill’s primary sponsor was Senator Jeb Bradley. It is now being considered by the House and on May 9, 2012 came out of the Ways and Means Committee with a 19-2 “ought to pass” recommendation.

The statistics regarding prescription drug abuse in New Hampshire are startling, and the impact is far reaching on the on the abuser’s family, his or her workplace, and the physician practice treating – and often unknowingly enabling - the abuser.  Prescription pain relievers are accessible, available and generally viewed as more benign than street drugs.  With the highly addictive qualities of medications like Vicodin and Oxycodone, which are among the most often prescribed, the consequences can be dire.

New Hampshire has the second highest level in the U.S. of young adults age 18-25 who report abusing prescription pain relievers. With 16.78% of New Hampshire residents in this age group reporting such abuse versus 11.94% nationally, red flags are raised. Nationally, there was a 40% increase in employees testing positive for prescription narcotic use between 2005 and 2009.  In 2010 Oxycodone became the second most abused drug after alcohol of those entering state funded substance abuse treatment. According to the New Hampshire Medical Examiner’s Office, the number of deaths in New Hampshire from Oxycodone overuse has more than tripled since 2000.

The Controlled Drug Health and Safety Act authorizes the New Hampshire Board of Pharmacy to contract for the creation of a secure program to electronically collect controlled drug dispensing data from pharmacies.  Licensed prescribers and dispensers would be able to access this data prior to writing a prescription for or dispensing a controlled drug. The information compiled would relate only to the most abused medications including stimulants such as Ritalin and Adderall, pain relievers such as Oxycodone and tranquilizers like Valium and Xanax.  Other prescription drugs would not be included.

For practicing physicians, the number of ethical complaints and medical malpractice actions which result from allegations of overprescribing to patients with drug seeking behaviors is growing.  Doctors may take a complete medical history, but without a method of verifying information from the patient, they have no way of knowing whether the patient may be abusing prescription drugs.  Most physicians who prescribe medication due to chronic pain complaints use tools such as pain contracts and drug testing to monitor medication levels, but the availability of electronic information to support the doctor’s clinical findings could be invaluable.

Surprisingly, New Hampshire is one of only two states, Minnesota is the other, which does not currently have this information sharing system in place. Since New Hampshire is surrounded by states with monitoring systems in place, it has the potential of becoming a magnet for out of state residents seeking controlled drugs. Why not visit the physician in Salem or the hospital in Derry who won’t know that the patient has already received Vicodin in Methuen, MA for the same neck pain?

Physicians appear united in the belief that the availability of this information would greatly enhance their ability to provide quality care to patients. With a prescription monitoring program in place, doctors would have access to information concerning what medications their patients have been prescribed by other providers before writing a new prescription. This would limit the ability of the drug seeking patient to go to multiple providers complaining of the same symptoms and seeking excessive amounts of medication which can later be abused or sold at a premium price on the street or in schools. 

It should be noted that SB 286 carefully balances the issue of patient privacy with the need of the physician for this information. Only registered prescribers and dispensers would have access to the information and only for patients in current treatment. The law also requires that the information sharing program at all times be compliant with HIPAA with severe penalties imposed for any attempt to misuse information. Even law enforcement would have access to the information only with a court order.

Employers, educators and families routinely experience the effects of prescription drug overuse. Employers struggle with lost productivity, excessive accidents and injuries and inability to fill positions with qualified workers.  Whole families suffer when breadwinners are unable to hold gainful employment due to substance abuse. Schools are required to be constantly vigilant, watching not only for alcohol and marijuana use but also now for the student sharing his Ritalin or his parent’s Vicodin. Physicians charged with the responsibility to prescribe medications in appropriate dosage and for good clinical reasons would greatly benefit in improving the care they provide and minimizing their own risk of liability if this important tool were available to them.

Charla Bizios Stevens is a Director with the McLane Law Firm. Ms. Bizios Stevens practices in New Hampshire and Massachusetts, concentrating in employment, health and education law.  She thanks the New Hampshire Medical Society, the Community Health Institute, the Business & Industry Association and New Futures for the information used to write this article.  She can be reached at 603-628-1363 or at [email protected].

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