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.
“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 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.”