To End Addiction Epidemic, States Focus On Stopping Doctor Shoppers

May 9, 2014
Originally published on May 9, 2014 6:45 pm

Nearly every state has a prescription drug monitoring program that's meant to end abuse of opioids and other powerful pain medicines. But critics say most of these programs have a big loophole: they're voluntary, and many doctors don't use them. States that have made participation in PDMPs mandatory say they've started to cut down on practices that allow pain meds to be diverted into the black market. But those states are the exception.

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Prescription painkiller abuse has been called the worst drug epidemic in U.S. history. It's so bad that nearly every state has started a prescription drug monitoring program. These program help doctors and pharmacists track the use of powerful painkillers, but they're mostly voluntary and participation is low. So, a handful of states are making prescription monitoring programs mandatory. That's over the objections of many doctors, as NPR's Joel Rose reports.

JOEL ROSE, BYLINE: Prescription monitoring programs are supposed to catch so-called doctor shoppers - people who go to more than one physician to get their hands on powerful pain meds, like Vicodin or OxyContin, either because they're addicted or they're reselling the pills on the black market or both.

DR. BRIAN DURKIN: We've kind of seen patterns where patients are very overly complimentary, almost too nice. You know, well, Dr. Durkin, you look very nice today. Did you lose some weight? Those kind of things. That's become a red flag to me.

ROSE: Brian Durkin runs the Center for Pain Management at Stonybrook Medicine on Long Island, New York. Until recently, Durkin relied mainly on his intuition to figure out if a patient was doctor shopping. Now, he's got another tool.

DURKIN: I just changed my password last week.

ROSE: Before Durkin can write a prescription for powerful painkillers, someone in his office has to log in and check the patient's prescription history in the state database. Durkin says some of the things he's learned have surprised him. Since New York's program became mandatory last summer, Durkin has caught a handful of patients getting pain pills from other doctors too, and he says they don't tend to fit the stereotype of a drug dealer.

DURKIN: It's not so much jittery people or young people. I've had 60-, 65-year-old people that turned out to be not taking the drugs that I prescribed, that you would never think were, you know, out there selling drugs. Every doctor's been fooled, I guarantee it. Guarantee every single doctor out there that's written prescriptions has been fooled.

ROSE: New York is one of a handful of states that have made it mandatory for doctors to check the state's prescription database. So do Kentucky and Tennessee. In those states, use of the database has more than doubled after mandatory reporting began. In Kentucky, the number of prescriptions for painkillers dropped by roughly 10 percent.

DR. ANDREW KOLODNY: Prescription drug monitoring programs are probably our best tool for bringing this crisis under control.

ROSE: Andrew Kolodny is the chief medical officer of Phoenix House, an addiction treatment organization, and the cofounder of Physicians for Responsible Opioid Prescribing.

KOLODNY: When we talk about opioid pain pills, we're essentially talking about heroin pills. If you were going to be prescribing a dangerous drug, taking two minutes to make sure that that patient hasn't been receiving it from other prescribers is worthwhile. And, unfortunately, if we don't make it mandatory, doctors are just not going to do it.

DR. ART ROUSSEAU: The majority of doctors do not like to be mandated to do something. You know, we want to be able to use our clinical judgment. That's why, you know, we're educated about the drugs that we're prescribing.

ROSE: Art Rousseau is a psychiatrist and chair of the legislative affairs committee at the Oklahoma State Medical Association. That state has a prescription monitoring program that's voluntary, but last year doctors checked the database for just one in every six prescriptions they wrote for controlled substances. Lawmakers in Oklahoma are debating a bill that would make the program mandatory. But Rousseau is worried that will leave doctors to spend valuable time running checks on patients who are clearly in pain. And if the process is too cumbersome, Rousseau says, some doctors might decide not to prescribe opioids at all.

ROUSSEAU: And I've heard doctors say that, including orthopedic surgeons, who, you know, routinely will prescribe some type of narcotic to help deal with legitimate pain but they're saying it's not worth it. So, that is a concern that patients that truly need this medication are not going to get it.

ROSE: I heard this again and again from critics of making these programs mandatory. Gregory Terman is a professor at the University of Washington and president of the American Pain Society.

DR. GREGORY TERMAN: My concern is that patients that might benefit from these medications may not have access to them simply because it's one more hoop to jump through.

ROSE: That is a real concern, says Brian Durkin at the pain clinic on Long Island. There are 116 million people in America who suffer from chronic pain, according to a study by the Institute of Medicine. And Durkin says opioids are the right treatment for some of them, but they should be the doctor's last option, not the first one.

DURKIN: There are people out there that legitimately do well with opioids. The trick is figuring out who those people are. Doctors don't like to be told what to do. Unfortunately, you know, that needed to be done because there was an epidemic and, you know, there still is an epidemic.

ROSE: Durkin says New York's monitoring program is still far from perfect. For instance, it doesn't tell him what pills his patients might have picked up in nearby states, like New Jersey or Connecticut. There's a bill in the U.S. Senate that would require state prescription monitoring programs to work together, but that bill is stuck in committee. Joel Rose, NPR News, New York. Transcript provided by NPR, Copyright NPR.