Fatal overdoses of prescription drugs are on the rise, but patchwork laws make them tough to stop
The woman who showed up in the emergency room of Boston Medical Center with a life-threatening apparent overdose of painkillers was contrite. She promised to follow a plan to ease her pain with medications that did not contain opioids, the principal ingredient of prescription drugs including oxycodone and fentanyl whose vast increase in use has led to an epidemic of overdoses.
Then she went across town and got another doctor to prescribe them anyway.
This kind of “doctor-shopping” by patients addicted to opioids is one of the primary reasons drug overdoses have become the leading cause of injury death in the Unites States. There were nearly 17,000 fatal overdoses of pain medications in 2011, the last year for which the figure is available, according to the Centers for Disease Control—more than from heroin and cocaine combined, and triple the number in 1990.
Yet 12 years after the launch of a federal program that encouraged states to share information about patients’ prescription histories, there remains no single national database to thwart doctor-shopping. Meanwhile, the various prescription drug monitoring programs in separate states follow a patchwork of different rules—including whether or not doctors are even required to check them before prescribing opioids to patients.
The safety net is even patchier for veterans, whose rates of opioid overdose are double the national average. The Veterans Administration medical system, the nation’s largest hospital network, serving nearly nine million people, only last year agreed to report its patients’ prescription histories to state registries or check prescriptions from outside providers. But the process is voluntary; VA doctors are not required to follow any of the safeguards.
“If you don’t use the system, you’re not going to detect misuse,” says Melissa Weimer, an assistant professor of medicine at Oregon Health and Science University and medical director at the substance-abuse treatment center CODA Inc.
Weimer is an advocate of sharing prescription information across state lines through so-called prescription drug monitoring programs, known as PDMPs. Many states have adopted PDMPs in the last few years in response to the overdose crisis and now every state except Missouri have or plan to develop a monitoring program. But the rules differ widely.
In many cases, registration by doctors is voluntary. Even among states that require doctors to sign-up and use the PDMPs, only a handful mandate that they check the prescription histories of every patient. Efforts to make that mandatory have largely failed after opposition from medical groups. In Oklahoma, which has the nation’s fifth-highest drug overdose mortality rate, a state House bill to require that doctors check the registry was defeated in late May after medical associations said it would be burdensome and legislators called it regulatory overreach.
“As soon as you start talking about databases and tracking people and tracking prescribers, there’s pushback,” says Daniel Alford, director of the Safe and Competent Opioid Prescribing Education program at the Boston University School of Medicine, who treated that woman in the emergency room. He says doctors ask themselves, “‘Do I want the feds monitoring my prescribing patterns?’”
The paperwork doctors are required to file under the current laws doesn’t have to be submitted by providers in most states for as long as seven days, and often takes another week or two to show up in the prescription monitoring system.
“If you’re an ER physician, that’s not going to do you any good if the patient you’re seeing has just been to another emergency room that day, getting more of the same drugs,” says Heather Gray, legislative attorney for the National Alliance for Model State Drug Laws, a federally-funded nonprofit research organization.
Then there is human error. Misspelled names or missing middle initials can make patients disappear in the shared databases.
“It starts to frustrate you to the point where you question whether you want to invest time in looking at this as opposed to doing other things,” says Alford.
Read more: Stopping America’s Hidden Overdose Crisis