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Washington state’s new drug monitoring program pits safety against privacy

A preventive medicine and pain management specialist in Tacoma, Wash., Kenneth L. Bakken, DO, DrPH, considers Washington’s Prescription Monitoring Program, which debuted this month, “well-intentioned but intrusive for conscientious clinicians and patients.”

Some DOs, however, view the program as an essential tool to help curb prescription drug abuse. In the state of Washington, more people die from prescription drug overdoses than from overdoses of illegal narcotics, such as heroin and cocaine.

For each prescription for a Schedule II through V medication filled in the state, pharmacists must submit a record identifying the patient, prescriber, dispenser, medication and dosage to a database overseen by the state health department.

In making their prescribing decisions, physicians can, but do not have to, access data pertaining to their patients. The state’s medical boards, as well as law enforcement personnel, have the right to access the new database in the course of their investigations.

One of dozens in the U.S., Washington’s prescription-drug monitoring program is the most recent. The state’s program likely will be one of the toughest on physicians who overprescribe, given the potential involvement of the state’s medical boards. The program was authorized by the state’s 2010 pain management law, intended to curtail opiate abuse, which counts among the country’s strictest laws regarding the management of chronic noncancer pain.

State prescription drug monitoring programs

Click on a state to see a program’s website and contact.

Arkansas, Delaware, District of Columbia, Georgia, Montana, Nebraska, South Dakota and Wisconsin have enacted legislation but their monitoring programs are not yet operational. (Source: Alliance of States with Prescription Monitoring Programs)

“I realize that prescription opioid abuse is rampant, but I don’t like the idea of someone peeking over my shoulder,” says Dr. Bakken, who sees only fibromyalgia patients. “I am very alert to and wary of government intrusion in all aspects of life. As is always the case, government oversight comes with limited financial resources for enforcement, as well as the opportunity for bureaucratic abuse.”

To weed out “doctor shoppers,” who seek prescriptions for opiate pain relievers and other controlled substances from multiple physicians, Dr. Bakken has already implemented several measures. He requires new patients to have two physician referrals. He also has his patients undergo urine and saliva drug testing to make sure they are taking their medication as prescribed and not obtaining pain medication elsewhere. And for years he has required patients to sign a contract stating that they will not seek pain medication from another physician. On top of these measures, the Prescription Monitoring Program is excessive and unnecessary, insists Dr. Bakken, who has been treating patients for chronic noncancer pain for more than 15 years.

Protecting patients

“I am 100% for the Prescription Monitoring Program,” says Michael P. Quirk, DO, a family physician and pain management specialist in Chehalis, Wash., who was among approximately 40 clinicians who beta-tested the program in December. “By using the database, I have already caught three patients who were doctor shopping,” he says. “One patient had recently obtained 270 10-milligram oxycodone pills before he came to me wanting 180 more pills. I showed him the report from the database. And he said, ‘So I don’t get the pills?’ ” Dr. Quirk refused to prescribe opiates for this patient.

“Prescription monitoring is a patient-safety issue,” says Daniel A. Brzusek, DO, of Bellevue, Wash., who also beta-tested the program. A specialist in physical medicine and rehabilitation, Dr. Brzusek is enthusiastic about the database because it lets him see not just whether his patients have knowingly obtained prescriptions for pain medication from multiple physicians but also whether they may unwittingly be consuming dangerous combinations of drugs.

“Most people don’t purposely overuse medications—they just don’t know any better,” Dr. Brzusek was quoted as saying in The Seattle Times.

Dr. Brzusek regards physicians who overprescribe opioid pain relievers as dangerous, and he points out that he has testified against them in court. Responsible physicians should view the Prescription Monitoring Program as a useful resource that will allow them to provide better care and prevent accidental deaths, he says.

Dr. Brzusek

Dr. Brzusek stresses that he doesn’t intend to turn patients with multiple opioid prescriptions in to the police. “Instead, I will say, ‘We have a problem here. How can I help you defeat this problem?’ In my experience, 98% of patients respond favorably to this approach,” he says.

Washington’s Prescription Monitoring Program is currently limited to prescriptions filled in the state, but the program will eventually connect with databases in Oregon, Idaho and Montana. Dr. Brzusek hopes that once every state implements a Prescription Monitoring Program, a national database can be established. According to the Alliance of States With Prescription Monitoring Programs, 40 states have operational programs and most other states have passed legislation to establish prescription monitoring.

More reasonable approach to curbing abuse?

Seattle psychiatrist Daniel E. Wolf, DO, welcomes the Prescription Monitoring Program as a better approach to curbing opiate abuse than the other provisions in Washington’s 2010 pain management law, which he considers to be too rigid overall. For example, the law limits chronic noncancer pain patients to an equivalent of 120 milligrams of morphine per day. And it requires physicians to thoroughly screen patients for substance-abuse tendencies.

“The law has many unintended consequences,” says Dr. Wolf, who has a special interest in addiction medicine. “A lot of physicians are now afraid to prescribe opiates for patients with severe pain. The law hurts legitimate patients.”

According to Dr. Wolf, many chronic pain patients in Washington have been terminated by their physicians, are turning to street drugs, or are ending up in emergency departments with withdrawal symptoms.

Rather than a cookie-cutter rule affecting how physicians treat every pain patient, prescription monitoring allows physicians to pinpoint patients who likely engage in opiate abuse, Dr. Wolf says. “If I can use the program to keep one patient from overdosing on medication, it is worthwhile,” he says.

But Dr. Bakken sees the Prescription Monitoring Program as more of a law-enforcement tool than a resource for relieving patients’ pain and curbing addiction. “Until we properly instruct physicians in pain medicine, legalize drug use in this country, and prioritize the narcotics problems financially in terms of public health rather than criminal law,” he argues, “we will never control this epidemic of abuse and pain and suffering.”

13 Responses

  1. robert migliorino,d.o. on Feb. 6, 2012, 5:12 p.m.

    See my comments re the law in Florida.Again,these laws are ineffective because prescribers don’t have the cojones or guts to say “NO”. The patient will always threaten to see someone else who will prescribe these products & there is always a goodly supply of them available.Prescribers include dentists,np’s,pa’s,& rph’s; not just md’s & do’s.

  2. Paul J. Morris DO on Feb. 6, 2012, 8:53 p.m.

    The Prescriptionn Monitoring Program has recently become active in New Jersey (as of January) and I have already found four of my patients to be “doctor shoppers”. I find the service invaluable, and I think it will greatly simplify the practice of proper pain treatment in New Jersey. I have screened all of my patients who are being treated for pain, and have found the vast majority of them are “behaving” themselves. In addition, I plan to screen any new patient who needs pain treatment with medication via the monitoring program.

    As far as the state using the program to monitor physicians: they could do that before the program went into effect, and often did. Doctors who treat pain responsibly have (hopefully) nothing to hide, and patients will no longer be able to use multiple prescribers and multiple pharmacies to obtain narcotics for illegitimate use. I think it’s a great step forward in pain treatment.

  3. Bruce Weaver DO on Feb. 7, 2012, 10:06 a.m.

    With respect to the recent issues surrounding the prescribing of controlled substances, I have found that many insurance companies have yet to acquiesce to the new recommendations and guidelines. An example of this can be elucidated in a case of insomnia. In my patient, who is a 47 year old white male, who was taking over-the-counter Unisom for insomnia was having symptoms that were consistent with prostatitis. Initial work up indicated a non-infectious cause. Consequently, an antihistamine induced prostatitis was considered related to antihistamine’s antimuscarinic effect on bladder neck and periprostatic smooth muscle. The decision was made to stop Unisom and hold all other antihistamines. I prescribed Rozerem for insomnia for its non-controlled status, non-antihistamine class, and non-addictive properties, and due to my previous good results with this medication. This prescription was denied by the patient’s insurance company, Blue Cross PPO, as the patient had not tried and failed at least one of the following: zolpidem, Sonata, or Lunesta. It seems that the insurance companies are not on-board with these new guidelines regarding controlled, addictive substances.

  4. Rachel Wise on March 12, 2012, 11:25 p.m.

    I am a patient in Washington State on Medicaid now running into these laws as they affect lower income persons already besieged with issues navigating through THAT system. I have chronic insomnia and have had no difficulty filling a prescription in the past. Suddenly I walked into the police department, not a health center. How did they know I wasn’t a drug dealer? Aaaah – they saw I had a string of doctors – no shit Sherlock, try this coverage — but nooo, that meant I must be “doctor shopping” for drugs to sell on the side. It was a disgusting, degrading experience — and no, I will not be submitting to the state’s facism — because it is not a question of addiction, but a question of health care they refused to give, and as a result, it will indeed cost the state even more. And although this is not my case, I can easily see why this law will drive more people into seeking drugs illegally. In short, I needed medication, and now, I don’t have medication — and because they don’t even think they need to tell people the laws have changed — they are such snots who think everyone is watching their world with rapt attention constantly — and I have a string of ruined medical relationships which is no joke on Medicaid – now left with NO health care at all, on this issue, all kinds of problems with the insurer, not to mention that I am sick as a dog right now — oh thank you so much medical nazis — doing this to me was a great step forward to saving people from dying of overdoses. If I’m in a car accident – I hope my car, at least, hits yours.

  5. Ion on June 4, 2012, 1:54 p.m.

    This is another fascist law tearing apart our freedoms
    in this country, all done for the good of the people.
    Reminds me of Socialist ROMANIA, all done for the good
    of the people.. Scammers and Drugdealers, thats what you
    all are, shame on you Washington, when people are committing
    suicide because of their pain. Here’s a800 mlg Ibuprofen for
    your chronic pain, oh wait, lets try this other new drug were
    trying to get on the market with all these other horrible side effects.
    Big Brother knows best, what a scam, SHAME ON YOU COMMIE-FASCISTS! >:p

  6. Ion on June 4, 2012, 2:31 p.m.

    Been going to Family Doc for 2yrs, and foot doc as well,
    went to urgent clinic over the winter for kidney problems.
    Had files transfered over to fam doc so there’d be no problems, our fam doc is in Idaho, we live in Seattle, so of
    course i went to an urgent care for the pain in my kidneys till I
    could see my reg doc, big no no, it’s called doctor shopping
    apparently. Medco sent a safety letter of concern to my insurance co and to my reg Doctor saying I had been to urgent care clinic and had gotten vicodin prescribed for my kidney pain which I had told my doc about
    and had my files transfered to show transparency. Nope, our family doctor had to discharge me, because it was multiple doctors prescribing the same drug which I already told’em about, because of this ”letter for my own safety” i lost a really good fam doctor, his hands were tied by the system which considered me an abuser because i let them know ahead of time what was up? What a joke you all are, treat us like adult human beings.Quit trying to push all these other more life threatening drugs down our throats

  7. Douglas on Dec. 20, 2012, 12:09 p.m.

    And Pharmasutical Conglomerits have a voice that kicked off this so called abuse by perscribers of their product. They say they are losing revinue by being cut out of the under ground market after sale by social addicts,or is it the law suites that show these Drug Cartels aka Medical Drug Companies accountability in this problem. It has involved the chipping away at the grip once held by society keeping all in check and under controle. Consecions and coprimises allowing some of the most vastley acumulated welth by drug pushers in dubble brested suites. All the deaths from this one class of “pharmasuticals” exceeds deaths from heroin overdose. We know from FBI reports the strength of haroin at an all time high. So ask yourself who has the best drug pushers now. sorry just couldn’t help it!

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  9. D Ayres RN on May 13, 2013, 6:21 p.m.

    May I say “WOW”..great idea…horrible ramifications. As a nurse I would embrass this concept. As a human suddenly struck down with rhuematoid arthritis and joints “locking up” I sufferred excruciating pain and was told by 5 MD’s, one ER and an urgent care, “I dont treat pain” and was left sufferring so badly that I jeopardized my life and had to seek out a non conviencional shall we say method of pain relief but it was better than a gun shot to the head. Welcome to WASHINGTON state..suicide rates are not so high due to cloudy skies…. Gives MD’s an excuse to be abusive, negligent and callused.

  10. magicka on June 1, 2013, 6:37 p.m.

    I’m actually against this whole legislation thing. If everybody was caught, prisons would be overcrowded and people who never would have thought of going to prison would go. I’m not defending abuse and addiction but as we all know we don’t come to terms with addiction until you’ve lost everything. There are pretty serious criminal charges that ruin people’s lives. And most addicts are not going to have ever heard of this charge. Addiction is treated way wrongly in this country. While elaborately speaking on how we are going to be hard on these people so our communities are safe, they turn the other cheek and add that we want the addict to get help. I hate to bust everybody’s bubble, but prison will not help any addict. In addition to ruining their life, the crime is such a severe felony that you will be moping floors the rest of your life. The only places you’re going to rent from are places with other felons like rapists sex offenders robbers and murderers. Serious criminals that get into the real street drugs. The pharmaceutical companies need to be held accountable for knowingly manufacturing drugs that will lead to dependence, addiction and withdrawal. Doctors need to think twice before ever introducing addictive drugs like hydrocodone pain or no pain. Once it is introduced, if they are an addict, they will go down the path to destruction ending up in prison and losing their homes, families and careers. I hope that soon physicians and pharmaceutical companies and the law will take responsibility instead of pointing the finger at addicts, drug dealers and cartels. Because we should know that you wouldn’t be looking at such a charge if we were buying pills from cartels. We would be worried about getting shot or having our legs sawed off.

  11. David on Sept. 19, 2014, 11:31 a.m.

    Madness is the word for Washington state opioid prescription discrimination against legitimate chronic pain patients! I recently moved here with chronic pain with no concerns (or knowledge of prejudice)about being treated appropriated for chronic pain with Hydrocodone for constant unrelenting and daily flaring of chronic systemic pain. Wow, I am shocked and cannot believe what I have experienced from pain doctors here in the Seattle area who refuse to recognize my agony and treat it appropriately as a caring doctor of medicine. The marginalized suffering masses they ignore are seen by God and these doctors will suffer themselves with Christ’s judgement of “as you judge, so will you be judged” They follow orders like good soldiers exceeding the letter of the law written and passed to stop drug abuse by increasing and promoting pain in those who do not abuse medications necessary to decrease their own physical suffering. I hope and pray that some power here realizes the crime being committed and stands up for those of us who stand in pain and sometimes can’t even stand. Washington state’s manic response to lower their prescribing of Opioid medication is madness, unjust, wrong, and discriminates against those of us who did nothing to have disabling chronic pain that leaves us scratching our heads in disbelief. We are left with choices to fight or flight or languish. All of these choices are difficult with chronic illness. Please have mercy upon us…

  12. Shelley on Nov. 29, 2014, 3:16 a.m.

    As a daughter of a medicare patient that sells and trades her pills this state isn’t doing enough. If she is asked to submit a u.a. she has no problem cause she saved a few and starts taking them before her appointments so her u.a. will show vicodin. She is on disability for a back injury she got while working. She settled her L and I case and now collects disability. So its people like her that got this law enacted and sadly it is only hurting people that truly need it. She has never been phased by it and easily found a way around it.

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