Lawmakers pushing drug database

An ex-cop, addicted to powerful painkillers after an injury, befriends a doctor and tries to acquire a blank prescription pad from his office. Taking charge of a regional drug ring, the officer travels from pharmacy to pharmacy, taking out prescriptions in his and his wife’s names.

It’s a case the state Attorney General’s Office announced this month in Westmoreland County. And without a grand jury investigation and help from state prosecutors, there’s little chance the pharmacists involved would ever have learned the suspect was allegedly dealing drugs.

While Pennsylvania maintains a prescription database, it lags far behind dozens of other states in scope of its information and speed of its updates. Only the most potent, addictive drugs are included, and access is limited to the Attorney General’s Office.

Legislation to greatly broaden the program – opening access to doctors and pharmacists for real-time updates on each patient’s prescriptions – has passed in the state House and is moving through the Senate. Pharmacists and law enforcement officials have hailed its likely passage, but privacy advocates worry that the law would give police warrantless access to everyday patients’ medical data.

Thousands more daily

There’s little dispute that prescription drug abuse is a serious problem in Pennsylvania. The state stands far above the national average for overdose deaths; more opioid pain relievers are sold here per person than in most of the country, according to the Centers for Disease Control and Prevention.

Prescription drugs accounted for much of Blair County’s overdose increase last year, the Mirror reported in February. Many involved multi-drug cocktails, prompting medical examiners’ reports to include causes such as “combined drug overdose.”

Opioids and similar painkillers are meant to do just that – kill pain, whether from an injury or surgery.

They can provide a mellow sense of relaxation, dulling the brain’s response to pain but risking long-term psychological and physical dependence.

A 2010 nationwide study, the National Survey on Drug Use and Health, showed 2 million people reported nonmedical prescription drug use for the first time – thousands of possible new addicts each day.

“Prescription drug abuse is a huge problem, and it’s just getting bigger every day,” Greg Drew, president of Value Drug Co. and chairman of Operation Our Town’s pharmacy roundtable, said.

To fight the wave of addiction, prescription dispensers and police must first understand how addicts get the drugs. For the vast majority, it’s not by theft or a mysterious drug dealer on a street corner; the drugs are found at home or seemingly legally at a pharmacy.

According to Centers for Disease Control and Prevention data, more than half of prescription drug users got their drugs free from friends or family. The next largest group, at 17 percent, got them directly through a prescription, but in both cases the drugs were likely obtained through ostensibly legal means.

Those on Medicaid are twice as likely to be prescribed painkillers and are six times as likely to overdose on them, the CDC found.

Doc shopping and pill mills

For those who want painkillers in large quantities, either for personal use or for resale, a common practice is “doctor shopping,” experts say.

Users might visit several doctors, get a prescription from each and get them filled at several pharmacies. Others might use “pill mills” – doctors’ offices that write prescriptions with no questions asked – but pharmacists keep note of questionable doctors and maintain the right to refuse service, Drew said.

It can be easier to simply travel from pharmacy to pharmacy, getting one prescription from each and paying in cash so insurance companies don’t catch on, Drew said.

Under Pennsylvania’s current prescription monitoring program, it’s unlikely pharmacists would catch on, either. They don’t have access to up-to-date data for each patient, and as pharmacist Jamie Moran of the Broad Avenue Thompson Pharmacy noted, they don’t have to submit real-time documentation on customers.

The present state system includes only Schedule II drugs, the most intensely addictive substances available by prescription. So if you have a past prescription for fentanyl, oxycodone or other powerful painkillers, it may be on record but is largely inaccessible to medical professionals.

So limited is Pennsylvania’s system that last year, the CDC gave it its lowest rating: “Did not follow any of the selected best practices … or did not exist.”

Dozens of states have more information-heavy databases, according to national lists. Many include all scheduled substances down to Schedule V, the least addictive or dangerous drugs covered under the Controlled Substances Act.

A bill now making its way through the state Legislature’s upper house would do the same here.

The greater good

“This database will serve multiple purposes, not the least of which is to help those who may be suffering with an addiction,” state Rep. Matt Baker, R-Tioga, said in an October statement hailing the state House’s 191-7 passage of his monitoring bill.

Under a complementary Senate bill, which received its first approval Wednesday, the state would vastly expand the scope of its monitoring: Pharmacists would have immediate access to an online database, drugs as low as Schedule V would be added to the system and a newly formed state board would monitor the so-called Achieving Better Care by Monitoring All Prescriptions Program.

“The data-sharing is fine. It’s needed,” said state Sen. John H. Eichelberger Jr., R-Blair, who isn’t listed as a sponsor but who claims to have pressed the idea for years. “As long as the law enforcement folks are comfortable with it, we shouldn’t have a problem with [passing] it.”

The process is relatively simple: When a patient gets a prescription – for hydrocodone, a newly covered drug, for example – the pharmacist would have three days to submit basic information on the exchange online. The filing would include the patient’s name and identifying information, the dosage, payment method and the prescribing doctor’s name, among other data.

If a pharmacist is suspicious of a patient, he can pull up the person’s records online. If another pharmacist filled a two-week painkiller prescription days earlier, for example, he can refuse service and tell the police.

“It’s just us doing our due diligence on a case-by-case basis,” Moran of Thompson Pharmacy said. “There might be an added step, but it’s also the greater good.”

Records would be maintained for four years, according to the Senate bill.

Police and federal law enforcement officials could access the data freely for the most addictive drugs, and with a court order for all others.

“It’s going to be helpful. Obviously down the road … we can say, ‘Hey, that guy got 300 hydrocodone in the last two weeks,” Logan Township Police Chief Ron Heller said.

Police would need only prove “reasonable suspicion” of a criminal act – a lower bar than probable cause. Under the original Senate bill, police would need a search warrant, but that requirement was dropped amid arguments that warrants are too slow to obtain.

“I know that law enforcement folks were very concerned when they tried to limit their access,” Drew said. “I don’t think it’s so much privacy as it is, ‘At what point does law enforcement go too far?'”

That question has been fought in courts across the country as recently as February.

A low standard

On Feb. 11, a federal judge in Oregon ruled that patients have a reasonable expectation of privacy over their records. In the case, a doctor and a group of patients, aided by the American Civil Liberties Union, successfully protested the U.S. Drug Enforcement Agency’s claim that its agents can access state drug data without a warrant.

“Reasonable suspicion is the standard that’s used in public schools or prisons. It’s a very low, seldom-used standard,” Pennsylvania ACLU Legislative Director Andy Hoover said.

While the House bill was successfully amended to raise the requirement to a full search warrant, Hoover said, a debate could be brewing to keep that higher standard in the final law.

Under the Senate bill, the board responsible for the database would form plans to help addicts secure treatment, but there are few specifics and no identified source of funds. Money for the entire program, including the electronic database, would come from the general budget, while pharmacists would be responsible for the necessary technology on their end.

Despite privacy concerns and the lack of a clear funding source, it seems likely that the bill could pass in some form. Gov. Tom Corbett pushed for a stronger monitoring program in his “HealthyPA” initiative.

The programs’ effectiveness in containing prescription drug abuse appears to be documented elsewhere: A 2013 Brandeis University briefing produced in conjunction with the U.S. Bureau of Justice Assistance states that established databases saw painkiller abuse rise at a slower rate than states that didn’t.

“They’re up and running in several states around us,” Drew said. “I think it’s really worth it.”