The system, available since 2007, allows registered prescribers and pharmacists to see if patients have visited multiple doctors to obtain prescriptions for controlled substances.
Despite the database's life-saving potential, only one-third of prescribers and one-fifth of the state's pharmacists are registered to use the system, said William Bronson, who oversees the system for the state Department of Health and Human Services.
Use rates are on par with the national average, Bronson said -- the other 49 states have similar systems or at least some type of related law on the books -- but other state officials, including Attorney General Roy Cooper, question why the numbers are so low.
State Rep. Craig Horn, a Republican from Union County, wants the state to require doctors and pharmacists to register.
"Prescription drug abuse is ... tragic not only because of the deaths, but because they're preventable deaths," said Horn, who sponsored a 2011 bill that would have mandated prescribers use the system and plans to propose another mandate next session. "It just hasn't become a habit, so I guess we'll have to make it a habit."
A state-commissioned University of North Carolina review expected out next month will provide a comprehensive overview of whether the program is fulfilling its intended purposes -- helping doctors to identify and help drug over-users and allowing investigators to counter prescription-related crime, Bronson said.
Safety vs. business
The program, created by a 2005 state law, and funded its first two years with a grant from the U.S. Department of Justice. It now costs about $230,000 yearly, paid for by fees researchers and medical professionals pay for licenses to work with controlled substances in the state.
Pharmacies must report every controlled substance prescription they fill, and Bronson said the resulting database contains 95 million entries. Prescribers and pharmacists can access a patient's prescription histories through a private log-in.
The process takes less than a minute, several doctors said. But because their office personnel can't pull the files, some deem it a hassle to use, said Nabarun Dasgupta, a epidemiologist at the UNC Chapel Hill, who researches similar systems nationwide.
Bronson said others are just resistant to change or don't trust the database's efficacy because it's new.
Still, recent activity on the database is giving Bronson hope. He said some doctors have started using the system to examine their prescribing habits and the number of registrations has been on the rise.
"Give us another three years or so," he said. "It's starting to catch on."
Even if the system catches on in doctors' offices, the policies of some pharmacies could stand in its way. Danna Droz, a former president of the National Association of State Controlled Substance Authorities and current administrator of Ohio's system, said pharmacy chains have been resistant to prescription management systems. They cite the costs of making the programs work with their internal computer systems, heightened vulnerabilities to computer viruses and workflow disruptions.
A recent exception is Wal-Mart, which began requiring its pharmacists to register with the system this fall. Rite-Aid does not require its pharmacists to register but allows them to access the system, spokesman Eric Harkreader said in an email.
CVS spokesman Mike DeAngelis said CVS pharmacists will be able to access the system within the next year, but some are skeptical of that promise. Jay Campbell, executive director for the state's Board of Pharmacy, said CVS has made similar promises in the past without coming through.
"It's hard to imagine that it's anything other than a view that accessing a resource like this somehow slows down the dispensing process," Campbell said. "If the rationale is that we don't want to impede production, in my opinion, that's indefensible."
At the start of November, the chain did not provide access in any states where it wasn't legally required.
DeAngelis said CVS prioritized providing Internet to stores in states that legally require pharmacist registration to a prescription-monitoring program, while states with optional databases were waitlisted. Though North Carolina still doesn't require access, he said the company is granting its stores here Internet access to avoid a "hodgepodge" of rules across states.
"We want it to be as efficient as possible," he said.
Legislating action
The bill Horn sponsored last year, which never made it past a subcommittee, mandated that all doctors and pharmacists pull 12 months of data from the system for each patient to whom they were prescribing or dispensing a controlled substance, except in emergencies.
Requiring physicians to pull reports every time and not at their discretion might lead them to ignore the data out of habit, Dasgupta said. Even if system use is mandated, he said he doubts all doctors will comply.
"The idea that we're going to pass a law and get to 100 percent, that's naive," he said.
Horn, who plans to introduce a similar bill in the next legislative session, said some mandate is necessary to make sure the system is used. He is, however, looking into whether it would be possible to expand access to staff while protecting privacy.
Tackling the problem?
Even as state officials want to expand the system's use, some think such databases could prevent people from accessing needed treatment or create new drug-related concerns.
Dasgupta said the program is a "simple technological solution to a complex biological and psychological problem."
The UNC Researcher helped found overdose prevention initiative Project Lazarus in Wilkes County, which at one time had the third highest overdose death rate in the nation, according to data from the U.S. Centers on Disease Control.
Based on his experience there, Dasgupta said he worries doctors will refuse to see patients who have sought multiple prescriptions and are exposed by the system -- causing dire results.
Others say that if the program succeeds in preventing doctor shopping, it could lead to an increase in prescription-related crimes as people turn to theft to obtain painkillers or use other drugs.
Northeastern states that have used the databases longer have more people in treatment for their prescription addictions, Bronson said, but they've also seen an uptick in heroin use.
"This is a really complex issue," Bronson said, who said the reporting system is just one of an array of tools needed to combat prescription drug abuse. "It's not a problem we can arrest our way out of; it's not a problem we can prescribe our way out of."
(c)2012 The News & Observer (Raleigh, N.C.)
