Many states intensifying opioid tracking programs

Long before the opioid epidemic, most states developed drug-tracking systems to allow physicians and pharmacists to check patients' prescription drug use, including painkillers, to determine whether they may be receiving too many pills, at too high a dose or in dangerous combination with other medications.

But few prescribers took advantage of the systems that in many cases including Iowa's are only voluntary.

Now, faced with a drug overdose epidemic that killed more than 63,000 people in 2016, at least 39 states are insisting that health professionals use the systems, known as prescription drug-monitoring programs to analyze each patient's prescription drug use before writing another prescription for highly addictive drugs such as Percocet, Vicodin and OxyContin.

In Missouri, the only state without a monitoring program, St. Louis County adopted a local drug-tracking system and made its use by physicians mandatory.

'We saw a big nationwide push this year to make prescription drug-monitoring programs mandatory, more comprehensive and effective, and easier to use,” said Chad Zadrazil, a legislative attorney with the National Alliance for Model State Drug Laws, a federally funded drug policy organization based in Iowa. He said some states also are expanding access to the databases to assist in public health initiatives.

In the past, drug databases were used primarily by police to track down pill mills, where doctors indiscriminately prescribe opioid medications for cash. And most pharmacists consulted them before filling a prescription. But few doctors took the time to review the databases before prescribing highly addictive opioids.

Until states began requiring physicians to use prescription drug-monitoring programs, fewer than 35 percent of medical professionals used the tracking systems to identify patients who may be at risk for addiction and overdose, Zadrazil said.

In Iowa, officials say fewer than half of of the state's prescribers are registered to use the voluntary program. Just 4 percent of dentists use it.

Some prescribers have complained Iowa's program is too cumbersome; the state says it is upgrading the system.

In states that require doctors to consult the program, Zadrazil said, physician usage rates exceed 90 percent.

Overall opioid prescribing has declined in those states as well, as have drug-related hospitalizations and overdose deaths. States also are seeing a rise in addiction treatment as more doctors refer patients to treatment after discovering they are taking painkillers from multiple sources and are likely addicted, according to an analysis from Brandeis University's Prescription Drug Monitoring Program Training and Technical Assistance Center.

The fate of Iowa's voluntary monitoring program is unclear. Lawmakers in the past have not found enough votes to make the monitoring program mandatory.

David Heaton, a Republican lawmaker from Mount Pleasant, co-chairs the Iowa Legislature's health care budget committee and has said the committee will produce some form of legislation this year to combat the epidemic.

Iowa Gov. Kim Reynolds has outlined initiatives to combat opioid abuse, but so far has not proposed legislation.

Although the American Medical Association supports physician use of drug-tracking systems to identify potential addiction and drug diversion to the black market, some state medical societies have argued against mandatory rules they say interfere with the practice of medicine.

Patients' privacy and legitimate pain needs, they argue, could be jeopardized by requiring busy physicians to investigate potential patient abuse of medications.

NEW FEATURES ROLL OUT IN OTHER STATES

In addition to requiring doctors and other prescribers to use the tracking systems before prescribing potentially addictive and deadly drugs, Wisconsin, Utah and a few other states are adding information to prescription drug-monitoring programs - including overdose rescues, hospitalizations for drug-related conditions and drug-related arrests - that can help physicians determine when to curtail a patient's use.

And for doctors who see a need for addiction treatment, Kentucky, Ohio, Virginia and Wisconsin include referral information about treatment services.

Arizona, Michigan, Ohio, Pennsylvania, Virginia and a handful of other states are revamping their programs to make them compatible with electronic health record software systems commonly used by physicians and pharmacists, Zadrazil said.

And nearly all states have started allowing busy doctors to appoint a delegate who can access the sensitive information and download patients' drug history into their medical records before their appointment.

At least 47 states have started adding drug-monitoring data from one or more nearby states so physicians can see whether patients are receiving medications from prescribers in other states.

More than half of all states have added a physician assessment function so doctors, nurses and other prescribers can see how their prescribing practices compare with others in their state, and whether and how often they are exceeding Centers for Disease Control and Prevention guidelines and state-imposed dosage and quantity limits.

Stateline is an initiative of the Pew Charitable Trusts and provided by Reuters.