Compact Aims to Cut Prescription Drug Misuse

E-newsletter #61/December 9, 2010

A quarter per prescriber: That’s how much states will be asked to pay for membership in a new prescription monitoring compact.

The cost for participating compact states is one of several details discussed at The Council of State Governments’ 2010 National Conference Dec. 6 in Providence, R.I. The compact has been in the works for a year, but policymakers got their first detailed look at the proposed compact during a half-day session at the conference.

The compact is designed to allow states with prescription monitoring programs to share information with other state programs. The goal is to cut down on doctor shopping and prescription drug misuse.

Kansas Sen. Vicki Schmidt, a pharmacist and chair of the advisory committee that developed the Prescription Monitoring Program Compact, calls the misuse of prescription drugs “an epidemic more deadly than crack cocaine or heroin abuse.”

In fact, said Jim Giglio, executive director of the Alliance of States with Prescription Drug Monitoring Programs, the abuse of prescription drugs has skyrocketed in less than two decades.

“You cannot pick up a newspaper or look at TV without hearing something with regard to prescription drug abuse,” Giglio said.

The data backs up the news. According to the Drug Abuse Warning Network system, in which hospitals voluntarily submit data about, among other things, the drugs they subscribe to the federal government, drugs containing hydrocodone—like Lortab and Vicodin—were mentioned less than 10,000 times before 1994. That increased to 57,000 mentions in 2008, Giglio said. Oxycodone received less than 5,000 mentions in 1996; that grew to more than 64,000 in 2008. Fentanyl was mentioned less than 100 times in 1994, compared to more than 7,800 in 2004.

In addition, the National Survey on Drug Use and Health, which surveys Americans over age 12 about drug use, found that pain relievers and tranquilizers followed only marijuana as the drug of choice in 2009. But Giglio said if you combine pain relievers, tranquilizers, stimulants and sedatives into a broader category of prescription drugs, that misuse would exceed marijuana.

In 16 states, more people died through drug-induced deaths than in motor vehicle accidents, Giglio said. From 2001 to 2006, he said, the number of unintentional poisonings increased by 175 percent.

“We have more and more people dying from these prescription drugs,” said Giglio. “Prescription monitoring programs are one of the more effective tools to combat the prescription drug problems.”

But even those programs need help. Take Kentucky, for instance. The Bluegrass State has a prescription monitoring program—the Kentucky All Schedule Prescription Electronic Reporting, or KASPER.

Program Manager Dave Hopkins said his program is just a start on the problem.

“Drug diverters and drug seekers are going all over, they’re crossing state borders on a regular basis,” he said. “Our users of prescription monitoring programs are demanding we give them data from other states on their patients.”

According to KASPER information, Kentucky providers filled 700,000 prescriptions written in the seven border states last year.  That doesn’t count all the other prescriptions written in the other 42 states.

“Most of these are legitimate people on vacation,” Hopkins said. “It shows you the potential for abuse and we do have a fair amount of trafficking across state borders.”

States are capable of checking in with other state monitoring programs, but they’d have to set up an individual account with every other state officials want to check, Hopkins said. More than 41 states have such programs now, and Hopkins said each state sets up such programs based on their needs. Using a standardized system through a compact, he said, would allow state providers to easily check records in any other state.

“That’s what they need to have for a full picture of what that patient is doing,” Hopkins said. “Do they have a drug problem? Are they a drug seeker?”

The interstate compact, Schmidt said, allows states to share prescription data across state lines while also protecting patient privacy.

Many state legislatures will consider the compact in their sessions that start in January. Rick Masters, legal counsel for CSG’s National Center for Interstate Compacts, said the compact will become effective when six states join.

“It creates not only obligations on member states; it really creates a governing device so these mechanisms can be carried out,” Masters said.

The compact language includes the fiscal note, as well as plans for security, technology and users of the information.

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