Pills and More Pills

Who Knows Where Illegal Drugs Originate and Who Acquires Them?

Over many years, pharmaceutical abusers have typically acquired drugs through doctor-shopping, forged prescriptions, or unscrupulous physicians and pharmacists working alone or in association; however, many of these individuals have been dissuaded from using these methods because of prescription monitoring programs (PMPs) and increased law enforcement scrutiny. So, of course, many ever-resourceful abusers have shifted to other means of obtaining pharmaceuticals such as theft, purchases from Internet pharmacies, or acquisitions from retail distributors.

EHR Debate

The debate over electronic health records (EHRs) has been gaining great attention. Some people are concerned about privacy while others are worried that EHRs will help the government with a takeover of healthcare. But few have focused on the potential benefits to patients. (Emily Singer, www.technologyreview.com, February 23 2009)

Technology Review reports some benefits to EHRs:

1. Hospitals with the most effective electronic medical record systems had healthier patients--they saw fewer deaths and complications--and lower bills. Researchers at John Hopkins University School of Medicine found that hospitals that rated highly on automated note taking had a 15 percent decrease in the odds that a patient would die while hospitalized. Hospitals with highly rated decision-support systems also had 20 percent lower complication rates. The researchers also found that electronic systems reduced costs by about $100 to $500 per admission. In summary, hospitals with automated notes and records, order entry, and clinical decision support had few complications, lower mortality rates, and lower costs. (Ruben Amarasingham, MD; Laura S Plantinga, ScM; Diener-West, PhD; Darrell J. Gaskin, PhD; Neil R. Powe, MD; Arch Intern Med; 169; 2009)


2. Electronic systems also seem to improve preventative medicine by boosting screening. A study from Harvard Medical School found that patients who were sent reminders for colorectal cancer screenings, which were generated from electronic medical data, were more likely to get themselves screened. Electronic reminders sent to physicians had no effect on screening rates, suggesting that patients may be an untapped resource in their own preventative healthcare. (Thomas D. Sequist, MD; Alan M. Zaslavsky, PhD; Richard Marshall, MD; Robert H. Fletcher, MD; John Z. Avanian, MD, Arch Intern Med.; 169; 2009)
  
3. Also, in the first study of its kind, Richard Tannen, M.D., Professor of Medicine at the University of Pennsylvania School of Medicine, led a team of researchers to find out if patient data, as captured by EMR databases, could be used to obtain vital information as effectively as randomized clinical trials, when evaluating drug therapies. (Karen Kreeger, "Penn Studies Show How How Electronic Medical Records Can Be Used to Test Drug Efficacy," www.eurekalert.org/pub, February 6 2009) According to research published in the British Medical Journal, statistical analysis of electronic medical record databases mimics results of clinical trials, predicting which drugs work best. This kind of data wouldn't replace clinical trials, but some scientists say EMRs could be used to supplement clinical trial data, to look at a drug's effectiveness in a more diverse population, for example. 

4. People might also have access to their own health data online through EMRs -- seeing their weight along with their cholesterol and blood pressure measurements plotted out over time, for example, is a good impetus to keep these measurements in check.

If these records showed all meds prescribed and purchased it would help pharmacists and physicians to curb prescription drug abuse. The information could be exempt from use in prosecuting the patient, but used to track providers who were over prescribing controlled meds. Prescription drug abuse is about as prevalent as illegal drug abuse. Many people sell their prescription drugs on the street for cash. Doctor shopping is a common practice, and is a real problem for ERs and providers, not to mention a nightmare that facilitates drug addiction.

Resistance To Changes

Here is an description of another fight for tracking of prescription drugs in California. (Andrew Pollack, "California Delays Time to Track Prescription Drugs," The New York Times, March 26 2008) California regulators agreed to delay by two years a requirement that all prescription drugs be electronically tracked as a means of thwarting counterfeiting.

"Pharmaceutical manufacturers told the California board that putting a unique serial number on each container would require changing their packaging lines, which would cost millions of dollars and take years. 

In a reprieve for the pharmaceutical industry, California regulators agreed on Tuesday to delay by two years a requirement that all prescription drugs be electronically tracked as a means of thwarting counterfeiting.

The California plan was to take effect next Jan. 1. And given California’s size and the ambitiousness of its plan, some experts expected the California system to become the de facto standard for the nation.

But in a meeting here on Tuesday, the California State Board of Pharmacy voted to delay the requirement until Jan. 1, 2011.

The vote was a response to complaints from drug manufacturers, distributors and retail pharmacists that they could not possibly be ready by next January. And rather than violate the law, they said, they would have to stop selling drugs in California.

“The vast majority of product will not move starting Jan. 1, 2009,” Ronald N. Bone, a senior vice president at McKesson Pharmaceutical, a large distributor, warned the board before its vote. He said only 100 of 650 drug manufacturers surveyed by McKesson would be ready to put the tracking system into effect by the deadline.

Some board members were skeptical of the industry’s arguments, saying a delay would leave patients at risk of getting fake or adulterated drugs.

“All I’m getting is ‘We can’t do it, we can’t do it, it’s too expensive,’ ” said a board member, D. Timothy Dazé. 

“And I ask, ‘What value do you folks put on a life?’ ” (Pollack)

Ohio Tracking

Even as Governor Strickland's new task force looks for better ways to stifle prescription abuse, law enforcement already has some tools. Doctors, pharmacies and law enforcement have a database they can check to see if someone is receiving the same or similar prescriptions from several doctors. Strickland charged the task force with pursuing additional strategies to increase the use of Rx reporting by doctors and pharmacists.
The Ohio Automated Rx Reporting System (OARRS) tracks every time an opioid or opioid derivative, which includes most painkillers, are prescribed or dispensed. If a registered authority types in the name of the person receiving the prescription, the OARRS will tell them what doctor prescribed it and what pharmacy gave it to him.

OARRS in Ohio is voluntary, not mandatory. So, it is a tool but cannot, in itself, be used as evidence in court. Hard copies will be required. So, the effectiveness against pill mill operations is very insignificant.

While all doctors and pharmacists report into the system, only one in five use it when filling prescriptions, according to Strickland's office. One of the goals of the Ohio Prescription Drug Abuse Task Force (OPDATF) is to increase the number of doctors and pharmacists who use OARRS.