State monitors for prescription addiction
Having closely watched drug addicts of all kinds for the last 14 years of his career, Champaign County Judge Jeff Ford knows how creative they can be.
Those addicted to prescription medication are often among the most clever.
"They are the most manipulative people you will find because they get by on their addiction by convincing professionals that they need their drug. They have to convince doctors, pharmacists. They have to be very good at it to be that convincing," said the veteran jurist who oversees Champaign County's drug court.
It's because of the minority who abuse prescription medication that Randy Malan has job security — as much as anyone in an Illinois government position can. He is the clinical director of the Illinois Prescription Monitoring Program and the director of clinical pharmacy and clinical support for the Illinois Department of Human Services.
Malan said that since the late 1950s, the state has tried to keep track of who is getting controlled substances and from where. With the advent of computer technology, the collection of that information got a lot easier.
In 2000, he said, the state tracked more than 800,000 controlled substance prescriptions at a cost of about $900,000 a year.
Currently, it tracks about 19 million prescriptions at a cost of about $450,000 a year — $250,000 from the state and another $200,000 from federal funds.
"This is literally everything ... from Valium, Lyrica for sleep, to Meprobamate for muscle relaxation, the ones where there seems to be a propensity for dependence," said Malan, one of three full-time people and two contractual employees who staff the monitoring program.
In a nutshell, prescribers and providers — such as doctors, physician assistants, certain nurses and pharmacists — voluntarily provide to the state the names of patients getting those prescriptions, what prescriptions they are getting, and where they are getting them. If Malan and his colleagues find someone who is going to multiple prescribers and providers within a 30-day period, they can alert the prescribers, who in turn can evaluate if the person is legitimately getting the medication or is just "doctor shopping," as the practice is colloquially known.
"One thing we are very, very proud of is if you look at the data, and I do," said Malan, "from Jan. 1, 2008, to now, the number of citizens of this state who had documented multiple prescribers and dispensers in the same 30-day period has fallen off by 66 2/3 percent. It definitely shows that government can be effective, efficient and cost-effective."
Malan said the 19 million or so prescriptions that his program tracks a year represents information from only about 30 percent of those who could use the system. That's about 13,000 prescribers and about 5,700 pharmacists, he said.
"What has transpired recently is several of the large box stores have mandated their pharmacists to enroll and use the system. They see this as a benefit to the functionality of their insuring the accuracy of and validity of the prescriptions," he said.
"When I took this over in 1998, the maximum number of investigations we were asked to generate reports for was 12 a year. Monthly, it runs at 100 now," he said.
The monitoring program is also available to law enforcement. Urbana police detective Duane Maxey is currently using it on an open case and has found a wealth of information, even how the patient is paying for the drugs.
"When we get a tip that an individual is seeking, say, (the painkiller) hydrocodone — that seems to be the biggest problem — we follow up through the pharmacist and the doctor in an attempt to find out if a crime has been committed.
"I have yet to find a doctor or pharmacist who has been anything less than helpful," said Maxey, who even developed a brief overview of the monitoring for his law enforcement colleagues to assist them in medication-shopping investigations.
Malan said he doesn't keep track of the number of arrests or prosecutions that result from the information provided to police, since he believes the program's primary purpose is to help health care providers.
"In the last update to the controlled substances act, which went into effect Jan. 1, 2012, it gave us authority to send out unsolicited reports to practitioners who had been identified as having patients who met the 'frequent flier' threshold. Since last Jan. 1, I have sent out over 500 registered letters," Malan said.
That threshold, he noted, currently stands at what would seem to be an eye-popping six different prescribers and six different dispensers in a 30-day period. An advisory panel has recommended it be lowered to three prescriptions from three different providers in 30 days.
Malan said most prescribers are grateful to be alerted. The effect is usually that if a doctor isn't enrolled in the program, he or she does enroll.
Besides being a bit of a detective, Malan, a pharmacist by training, has to use common sense, compassion and his clinical knowledge before deciding to send a letter to a prescriber.
An oncologist treating terminal cancer patients or a palliative care doctor whose purpose is to make a dying patient comfortable is less likely to get a letter because "from a clinical standpoint, it appears to be a sound approach."
Dr. Steven Schmidt, a medical doctor for 30 years who specializes in pain management, said he's used the monitoring program for about a year. He currently serves as division head of the Carle SurgiCenter in Danville.
"Our emergency room uses it regularly," said Schmidt.
Judge Ford noted that emergency rooms are attractive to prescription drug addicts because "the first thing the ER doctor will do is try to alleviate pain."
Schmidt said Carle already has a fairly sophisticated electronic record-keeping system that lets Carle doctors see if a patient is doctor- or drug-shopping.
"If the patient goes outside the Carle system, (monitoring) allows us to follow them if they obtain prescriptions," he said, noting the program might be of even more benefit to the solo practitioner with less access to patient records.
While Schmidt acknowledges the benefit of such regulatory tools as the monitoring program, in general, government regulations regarding prescription narcotics do have a downside.
"The tragedy is, as regulations get tight on prescription narcotics, the legitimate patients who need help are getting pinched and getting pinched badly. The system is so complex that a number of providers don't do it any more," he said.
"As a pain practitioner, I've stepped up and said, 'I know how to do this and I will do it.' This resource is helpful. It's just one more tool to weed out those abusing the system," Schmidt said.