Prescription Databases Weigh Public Health Against Patient Privacy
Kentucky's “pill problem” and the state's plan to fix it unfolded before a national gathering of state lawmakers in Washington D.C. Thursday (December 6).
As David Hopkins, director of Kentucky's prescription drug monitoring program, shared the state's prescription numbers —about 60 million prescriptions in August 2012 alone for a population of about 4.4 million — legislators attending the National Conference of State Legislatures session shook their heads in disbelief. “It is an awful lot of pills,” Hopkins said.
To tackle the problem, the Kentucky legislature passed a sweeping bill in April, beefing up enforcement and requiring all prescribers to enter each prescription they write for scheduled drugs, any drug identified by the U.S. Food and Drug Administration as potentially addictive, into the state's existing prescription monitoring database.
While 42 states have operational prescription drug monitoring databases, few require physicians to check their database before prescribing scheduled drugs. Kentucky, which ranks sixth in the nation in overdose deaths from prescription pain relieving opioid medications like oxycodone (OxyContin) or hydrocodone (Vicodin), now mandates that all prescribers must create a profile for each patient and check the database before writing or refilling a prescription.
Law enforcement officers wanting to access the database are required to have an open investigation with a valid case number. As Stateline has previously reported, law enforcement access to these sensitive databases has generated major debates as states have tried to address the national surge in prescription drug abuse.
Earlier this year, Vermont legislators and Governor Peter Shumlin battled privacy advocates concerned about allowing police access to the state's database without a warrant. In Kentucky this year, the attorney general wanted to take control of the state's database from the Cabinet for Health and Family Services, but in the last hours of the legislative session, the attorney general's office lost that argument as a result of patient privacy concerns.
Every state except Missouri has either implemented or passed legislation to create a prescription drug monitoring program as a way to combat prescription drug abuse. But, as Christopher Jones, a health scientist at the Centers for Disease Control, pointed out in his presentation Thursday, evidence on the effectiveness of the programs and what makes for a successful program are still a bit unclear. Few peer-reviewed studies have been conducted, and based on data collected through 2005, having a prescription drug monitoring program in place showed no clear impact on overdose mortality.
Although research is still sparse, Jones said, there's not enough evidence to show that states shouldn't have a monitoring program. Numerous surveys have found that physicians and law enforcement officials found these programs immensely helpful, Jones said. A 2010 survey found that 73 percent of Kentucky law enforcement officers who used the prescription database called the tool “excellent” for obtaining evidence.
Going forward, Jones said doctors really need systems that share data with other states, to alert them when people are crossing state lines to get more pills. For instance, doctors in Indiana and Ohio can see prescription records from both states, but Kentucky doctors cannot.
Doctors also want more instantly available data to make sure that their prescribing decisions are based on the most up-to-date information, Jones said. Some states update their prescription database only once a week or even once a month. When explaining why they don't use the system, Jones said, “doctors often say, ‘well, this data's old and I don't know how useful it will be.'"
Oklahoma has the fastest updating system at every 15 minutes. As part of their new law, Kentucky will update its database every 24 hours beginning in July 2013, Hopkins said.