It puts a big hurt on Louisiana’s illegal pill trade, sends up a red flag on legitimate patients abusing prescription drugs, encourages pain management doctors to do the right thing and discourages doctors from doing the wrong thing.
Louisiana is the 16th state in the nation to adopt a prescription monitoring program, which involves a Web-based database doctors can use to see what controlled substances their patients are getting and where. Dr. J. Michael Burdine, with the Spine Diagnostic & Pain Treatment Center, says it has huge implications for “doctor-shopping,” the practice of obtaining prescription drugs from multiple physicians.
It’s illegal to doctor-shop, though it’s not illegal for a physician to write prescriptions to a doctor-shopper. That’s because the practice has been difficult to detect—up to now. A clever doctor-shopper paying cash and always using a different pharmacy for each physician—always the same pharmacy for a given physician—could work the system with impunity.
“We’ve had patients coming to the clinic with as many 22 different physicians writing scrips,” says Burdine, president of the Capital Area Medical Society. “No one to this point was able to know that.”
Anyone seeing that many doctors is selling the pills to somebody else who’s selling them on the street. Burdine says the seven doctors in his practice used to give the boot to about two doctor-shoppers a week. Immediately after the program’s Jan. 1 launch, the number jumped to about 10 a week—though it quickly subsided.
“Already we’re finding that our numbers are starting to drift back down,” Burdine says.
Patients caught doctor-shopping are confronted and counseled. If it’s just a case of a patient taking too much medication, Burdine’s clinic offers the option of referral to a treatment program. If it appears that a patient is selling the pills, however, they’re turned over to law enforcement.
“It’s pretty obvious who’s doing that,” Burdine says.
The program is also having an effect on the streets. Burdine says he heard from state police that the black-market price of a tablet of Oxycontin rose from $40 to $80 in the first three months after the program was implemented. It’s also going to have an effect on the pain management industry. Burdine says there are still doctors in Baton Rouge selling prescriptions, but it’s hard to tell how many. The new program, however, “eliminates the physician’s ability to claim ignorance,” he says.
“This is really going to put those questionable physicians in a quandary,” Burdine says. “If a patient is clearly doctor-shopping, and you don’t investigate, and the patient is either selling the drugs or using drugs in excess, you would wonder whether there would be physician liability or culpability.”
Doctors peddling pills probably will pretend the new information doesn’t exist. But it’s going to look bad if an issue arises with a patient, Burdine says, adding the monitoring program could even justify legislation making it a crime to prescribe to doctor-shoppers.
“I would not want to try to answer the question as to why I didn’t use it,” says Malcolm Broussard, executive director of the Louisiana Board of Pharmacy. “There is no requirement to use it. The law does not require it. However, I would suggest that in a fairly short period of time this will become a standard practice.”
The pharmacy board set up the task force in 2004 that led to the program’s creation and now oversees it. Broussard says the program addresses what has long been a serious problem in the state. The database was established using federal grant money, but it’s supported through a subscription fee from pharmacies, doctors and anyone else licensed to prescribe or dispense narcotics.
Broussard notes, however, it’s not possible to make a definitive determination of what a patient is up to just based on the data in the system. A patient going to several doctors, for example, could be a hospice patient being treated by different doctors for terminal pain. Multiple pharmacies and doctors and high prescription volumes suggest a different story, though the records themselves don’t make the case. The monitoring data can’t be admitted as evidence, Broussard says.
Law enforcement can’t go fishing in the database for lawbreakers. Only pharmacists and doctors have access to the database, though if they suspect illegal activity they can notify law enforcement, which can then come to the pharmacy board with a warrant for a specific case.
“All this does quite frankly is it shortens the investigative time for law enforcement,” Broussard says. “Prior to this, police working on a suspected drug-shopper would have to guess which pharmacy—physically go to every pharmacy.”
He says the board has had more than 100 queries so far from law enforcement—mostly state police. Between 800 and 900 doctors and pharmacies, meanwhile, have access to the database.
Dr. Sandra Weitz, who practices anesthesiology and pain medicine, says the monitoring program is a useful tool in weeding out opportunists from legitimate patients. She says each time her clinic sees a patient, they’re asked to sign a “narcotic agreement” attesting that they haven’t received pain medication from any other doctor since their last visit. Patients are also drug-tested to make sure they’re in compliance.
All those things make it much harder for people to abuse the system, Weitz says, and the monitoring program only raises doctors’ comfort level in writing pain prescriptions.
“There are people who do the right thing, who are legitimate patients who have real problems, who have a real need to be treated,” she says. “Unfortunately, in society, there are always people who try to bend the rules or just flagrantly do the wrong thing. As a result, frequently innocent, well-deserving patients get penalized for the people who are doing the wrong thing.”
