Prescription pain pill monitoring limited by delay in reporting

Signs advertising pain management are common along Dr. Martin Luther King Jr. Boulevard in Tampa, where officials conducted raids in June to crack down on prescription pain-pill abuse.

STEPHEN J. CODDINGTON | Times

Signs advertising pain management are common along Dr. Martin Luther King Jr. Boulevard in Tampa, where officials conducted raids in June to crack down on prescription pain-pill abuse.

Florida's prescription drug monitoring program, set to kick off in December, is being touted by many as an important tool against an epidemic that last year killed close to 2,500 people — about seven a day — in the state.

But it won't necessarily catch some of the worst offenders, the doctor-shoppers who visit numerous doctors and pharmacies in just a few days, and walk away with hundreds — even thousands — of oxycodone, Xanax and other pills.

It won't catch them because the drug monitoring law gives pharmacists and doctors 15 days to enter a person's prescription information into a statewide database. Law enforcement officers say that's plenty of time for someone to buy lots of drugs and disappear before their name appears in the system to alert providers of their activity.

"You could make a million dollars in 15 days," says Pinellas sheriff's Detective Phil Mansfield.

State officials say the window is meant to give pharmacists and doctors enough time to learn and get used to a new system, and they hope that time frame is reduced in the future. And they also note that the more than 30 other states with drug monitoring plans all give medical personnel a week or more to enter the information.

"It may not catch that person doctor shopping the first time, but maybe the next time," said state Sen. Mike Fasano, R-New Port Richey, who sponsored the bill that was passed by the Legislature last year. "It will have a positive impact."

• • •

When the database comes online, pharmacists and doctors will be required to report information on anyone who has a prescription filled for drugs classified as Schedule II through IV, which includes substances like oxycodone, amphetamines, Vicodin and Xanax. Doctors will then be able to see if the patient asking for pain pills recently got a month's worth down the street.

They must enter identifying information for the patient, the drug and the doctor within 15 days of the transaction. If they don't, it's a first-degree misdemeanor.

The state is still setting up the system. The Department of Health received bids from six companies last week, and expects to choose one by the end of the week to build the system, said Diane Orcutt, who oversees the program for the department. She expects some bids to come from companies that created monitoring systems in other states.

Because of privacy laws, only pharmacists, doctors and a limited number of others will be able to view information in the database. Law enforcement officers can only access information on people who are the subject of active investigations.

Officers say the database will aid in their efforts to catch doctor shoppers. Currently, building a case can involve a lot of legwork, including trips to multiple clinics and pharmacies to examine records. But with the database, that information will be available in a few keystrokes.

"It will certainly help," said Capt. Robert Alfonso, head of the Pinellas Sheriff's Office Narcotics Division.

• • •

But the database won't turn up many who do the most damage.

The worst offenders work quickly, said Mansfield. He pointed to a couple of recent cases. One involved a Pinellas County man who, between Jan. 28 and Feb. 8 of this year, obtained nearly 1,000 oxycodone pills from different local doctors. Another involved a woman whose similar campaign yielded more than 1,000 pills, mostly oxycodone but also Valium and Xanax.

Though both were eventually arrested and face charges of doctor shopping and trafficking, Mansfield said the drug monitoring system isn't set up to catch them.

But it will catch many abusers, says Bruce Grant, director of the Governor's Office of Drug Control, which is working with the health department on the monitoring program.

"The folks that do it don't just do it one time and quit," Grant said. "They do it again and again. You will pick them up."

He added that even in the case of the doctor shoppers who fly in from other states and then leave quickly, their information will be entered into the state database within 15 days, and they will get flagged if they return for another shopping trip.

• • •

Fasano said he had pushed for a seven-day reporting window in Florida, but that doctors and others expressed concerns about the time it would take to learn a new system and make it part of their regular routines.

Officials with the Office of Drug Control said pharmacies had legitimate concerns about the time and resources that would be needed to enter information into the database. Small pharmacies, in particular, might not be adequately staffed to submit information on a daily basis.

Maja Gift, director of pharmacy at Tampa General Hospital, said it's difficult to know at this point whether 15 days is too much — or too little — time.

"It's really hard to make that judgment because we haven't seen what the system is going to look like," she said.

As it is, all of the more than 30 states with drug monitoring programs give pharmacists and doctors a week or more to report their information. Kentucky, which is widely considered to have one of the best prescription drug monitoring laws in the country, has a seven-day window.

David Hopkins, project manager for the Kentucky All Schedule Prescription Electronic Reporting system, said when the program launched in 1998, doctors and pharmacists were given 16 days to report information. That was reduced to eight days in 2006 and seven days in 2009.

He said most pharmacies in Kentucky have the computer systems and resources in place to report the data more quickly, but that's not necessarily the case with smaller pharmacies, some of which still send in their prescription drug reports to the state by fax or regular mail, he said.

The state is working with the University of Kentucky to study what it would take to implement a real-time reporting system, Hopkins said. That study is due at the end of the year.

"Real-time is desirable. The more current the information, the better it's going to be," he said.

"But even data that is 15 days old is better than no data at all."

Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330.

FAST FACTS

How it will work

Details about Florida's prescription drug monitoring program:

• Passed by the Florida Legislature in 2009, it calls for the state to set up a program by Dec. 1 that requires pharmacists, doctors and others who dispense certain prescription medications to enter information into a state database.

• They must enter the name, address and birth date of the customer; the name, quantity and strength of the drug; and the name and Drug Enforcement Administration registration numbers for both the prescriber and the pharmacy within 15 days. If they don't, it's a first-degree misdemeanor.

• The database will allow doctors and pharmacists to see what drugs a particular patient has been prescribed and obtained, and when.

• Florida's system is still out for bid, but many systems in other states are web-based, meaning most pharmacists and doctors submit the prescription information through a secure website. They can also use the site to access patient information before they write or fill prescriptions. The state expects to hire a small staff to run the database.

• The law doesn't require everyone to submit information. For example, doctors and others who give medications directly to patients in hospitals, nursing homes and in-state correctional facilities are exempt.

• Law enforcement agencies will be able to obtain information from the database only in cases where there is an active investigation. Privacy laws forbid them from trolling the database for possible abusers.

• For more information about the program, visit flgov.com/drugcontrol/pdmp/index.html.

Prescription pain pill monitoring limited by delay in reporting 07/23/10 [Last modified: Sunday, July 25, 2010 12:50am]

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