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Monday, July 12, 2010

Monitoring and Courts

What can help the epidemic of drug abuse in Appalachia? Much research is being conducted and many professionals are uniting to help curb the deadly problem. In fact, Appalachia is dealing with addiction, death, and related criminal activity on many fronts. The Appalachian states are facing drug addiction head-on. The solutions to such horrific destruction always depends upon good education and intelligence; however, when in the midst of a storm, people expect action and results immediately. Here are some things to consider.

Drug Courts

Drug courts are one way states are trying to decrease prescription drug misuse and the unintentional deaths associated with it. According to the National Drug Court Institute, researchers find drug courts a solution that works with nonviolent offenders. The institute found drug courts to “work better than jail or prison, better than probation and better than treatment alone. Drug courts significantly reduce drug abuse and crime and do so at less expense than any other justice strategy.”

The Department of Justice has funded drug courts since 1995, and courts are operating in all 50 states, U.S. territories and more than 70 tribal locations. Federal funding for developing state drug courts has historically attracted state and local funding at seven times the federal investment, once the drug courts started to realize savings.

Although up-front costs for drug courts were generally higher than for probation, drug courts were found to be more cost-effective in the long run because they avoided law enforcement efforts, judicial case-processing and victimization resulting from future criminal activity.

Drug courts exist in fewer than half of U.S. counties and only serve a fraction of the drug offenders who could benefit from the services, according to the National Association of Drug Court Professionals.

In his experience, Judge Lewis Nicholls, a retired Kentucky senior judge, found 80 percent of defendants in the
criminal justice system were addicted or drug dependent, and two-thirds of them were taking prescription medication. He credits the combined supervision and drug treatment available through the state drug court program to reducing the drug court recidivism rates to 20 percent compared to 57 percent among those who received prison and parole. “Drug courts work exceptionally well for clients whose crimes are motivated by an addiction to prescription drugs,” Nicholls said.

1. A recent study of nine adult drug courts in California reported that re-arrest rates over a 4-year period were 29% for drug court clients (and only 17% for drug court graduates) as compared to 41% for similar drug offenders who did not participate in drug court.  

Carey, S. M., Finigan, M., Crumpton, D., & Waller, M. (2006). California drug courts: Outcomes, costs and promising practices: An overview of phase II in a statewide study. Journal of Psychoactive Drugs, SARC Supplement 3

2. A recent long-term evaluation of the Multnomah County (Portland, OR) Drug Court found that crime was reduced by 30% over 5 years and effects on crime were still detectable an astounding 14 years from the time of arrest.

Finigan, M., Carey, S. M., & Cox, A. (2007, April). The impact of a mature drug court over 10 years of operation: Recidivism and costs. Portland, OR: NPC Research, Inc.

3. Another economic analysis in California concluded that drug courts cost an average of about $3,000 per client, but save an average of $11,000 per client over the long term. 

Carey, S. M., Finigan, M., Crumpton, D., & Waller, M. (2006). California drug courts: Outcomes, costs and promising practices: An overview of phase II in a statewide study. Journal of Psychoactive Drugs, SARC Supplement 3.


Controlling Misuse and Abuse

As of November 2008, 32 states had monitoring programs for prescriptions filled within their borders. Since
2002, the Department of Justice’s Harold Rogers Prescription Drug Monitoring has supported program development, and the number of states operating programs has more than doubled—from 14 to 32.
But the programs are costly: The Department of Justice estimates it costs $350,000 to start a state prescription drug
monitoring program, and the states operate the programs with annual budgets ranging from $100,000 to $1 million.

All prescription drug monitoring programs are designed to protect patient privacy and specify who has access to the
information. Physicians and pharmacists are educated on how they can request information from the program to better manage a patient’s drug regimen, refer patients for addiction treatment and reduce the availability of drugs for overuse.

Law enforcement officials can request prescription information when gathering evidence of prescription drug diversion, enabling them to act more efficiently and quickly by identifying the pharmacies where prescriptions were filled.

States estimate prescription programs can save at least 80 percent of the time spent on investigations because officers don’t have to investigate every pharmacy where prescriptions may have been filled. A 2006 study by Simone Associates also found that monitoring programs reduce the per capita supply of prescription pain medications in a state.

1. States are also working together to strengthen efforts to prevent diversion of prescription drugs. Prescription drug diversion is "the illegal removal of a prescription drug anywhere along its path from the manufacturer to the patient," said John Burke, president of the National Association of Drug Diversion Investigators.

2. Some state public health agencies, such as Massachusetts, exchange bulk prescription data— without patient identifiers— with neighboring states to determine how many people are crossing state lines to fill prescriptions. The results are used to educate in-state physicians on these trends.

3. State prescription programs are also working together to evaluate program costs and benefits by developing performance standards and monitoring expected outcomes.

4. In regard to doctor shopping, even with the advances in prescription tracking programs, only a few states are working to develop a system to share information among states.

Information sharing could be important, especially when it comes to doctor shoppers—those patients who shop for prescriptions from multiple doctors, often in bordering states where no prescription program exists, according to the U.S. Drug Enforcement Administration.

Danna Droz, administrator for the Ohio State Board of Pharmacy’s prescription drug monitoring program believes out-of-state information is vital to a complete picture of controlled drug use or misuse in a particular community or state. Droz reviewed prescription data from six states—Virginia, New York, California, Ohio, Kentucky and Nevada—and found up to 15 percent of prescriptions in each state are written by out-of-state prescribers and up to 7 percent of patients are from out of state.

“As prescription drug abuse continues to expand, pharmacists and prescribers have a greater need to monitor the prescriptions that their patients receive,” said Droz. She said medical professionals can sign up for multiple state prescription drug monitoring programs to obtain prescription history information, but it is an inefficient and time-consuming process.

“A much better approach would be to create a system where a prescriber or pharmacist could make one requestto access prescription data from more than one (prescription monitoring program),” Droz said. The Kentucky legislature authorized sharing prescription monitoring information with other states in 2005, and Kentucky
and Ohio plan to begin sharing information this year. Working with the Department of Justice-funded Integrated
Justice Information Systems Institute to develop the technological solution, the two state systems expect to exchange test data by early this year.

The pilot project uses a secure hub server that communicates only with state prescription management program databases. The monitoring programs encrypt all prescription data for privacy reasons when it is passed through the secure hub. For example, an Ohio physician who wants information on his patient’s prescriptions filled in Kentucky makes the request to the Ohio program. The Ohio program then encrypts the request and passes it through the secure hub to Kentucky. The Kentucky program would open the request and send an encrypted response back through the hub to Ohio. The Ohio program then opens the response and transmits it to the requesting Ohio physician.

Dave Hopkins manages the Kentucky Cabinet for Health and Family Services prescription drug monitoring program
known as KASPER and is vice-chair of the Department of Justice steering committee of eight states and six technology vendors working on sharing prescription data between states.

Hopkins said the Kentucky program has worked to develop standards, agreements and software to enable data sharing with other state drug monitoring program since early 2008. Kentucky expects to be able to share data with Ohio and one other state this year. “We have had strong direction from the state legislature and Secretary Janie
Miller to implement this system and by late 2009 we expect to be able to share data to support patient treatment by health care providers and to expedite our investigation of Kentucky residents involvedin illicit prescription drug use across our borders,” Hopkins said.

But sharing this kind of information also comes at a cost. The Integrated Justice Information Systems Institute estimates it could cost from $100,000 to $200,000 for state prescription monitoring systems to participate in this kind of hub-based datasharing among states, depending on the existing capabilities of the state system.

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