• Mission & Governance
• Services Overview
• How to Get Involved
• Standing Committees
• NCSL Foundation

• Issue Areas: A-Z
• State-Federal Relations
• NCSL Standing Committees
• News from D.C. and the States

• About State Legislatures
• Elections, Campaigns & Redistricting
• NCSL's StateConnect Directory
• Web Sites

• Online Guide to NCSL Services
• Staff Sections and Networks
• Meetings & Professional Development
• Staff Directories

• Meetings Calendar
• Online Registration
• Meetings Home Page
• Legislative Summit

• Bookstore
• State Legislatures Magazine
• NCSL's StateConnect Directory

Prescription Drug Abuse

By:  Allison C. Colker, Esq.

June 30, 2005

---

Introduction

Society reaps great benefit from pharmaceuticals, with each new “wonder drug” improving upon the good of previous.  As increasingly powerful and effective pharmaceuticals enter the market to ease pain and alleviate suffering, a concurrent risk exists that these drugs may be used for nonmedical or recreational use.  Ultimately, with many of these drugs, a great potential exists to develop addictions that could lead to debilitation or death.  Prescription drug abuse is a continued problem for states, despite controls such as prescription schedules.  Because recent national surveys indicate that prescription drug abuse is on the rise once again, many states are turning to additional measures—prescription drug monitoring programs, most notably—to prevent misuse of pharmaceuticals.

Overview

The 2003 National Survey on Drug Use and Health (NSDUH) revealed that some 19.5 million Americans (8.2 percent of the population) age 12 or older are current illicit drug users.  Of this total, 6.3 million abuse prescription drugs (2.7 percent of the population), a figure second only to use of marijuana at 14.6 million (6.2 percent of the population).  The NSDUH defines “current” as use of the indicated drug during the month prior to the survey.

The prescription drugs most commonly abused fall into three general classes: opioids (most often prescribed for severe pain), central nervous system depressants (most often prescribed for anxiety and sleep disorders) and stimulants (most often prescribed for ADHD, narcolepsy and obesity).

Preventing the diversion of drugs that treat such a wide swathe of disorders is a careful balancing act for physicians, pharmacists and policymakers as they attempt to ensure that prescription drugs are available for those who need them and those who merely want them.  These groups seek to prevent addiction and diversion through a range of methods, from keeping on the lookout for “doctor shoppers,” to employing information technology solutions, to requiring greater security at pharmacies and dispensaries.

Source:  National Institute of Drug Abuse Research Report Series, Prescription Drugs:  Abuse and Addiction, NIH Publication No. 01-4881 (Bethesda, Md.:  NIH, 2001).

Prescription Drug Monitoring Programs

Prescription drug monitoring programs (PDMPs) collect information to help state law enforcement and regulatory agencies identify and investigate illegal practices related to controlled substances.¹  They are intended to support state laws to ensure legitimate access to the drugs, while preventing illegal diversion.²

Overview of Current Programs

Current programs involve either the use of multiple prescriptions or electronic transmission.  Multiple prescription programs require physicians to use multiple-copy, state-issued prescription pads that contain serial numbers. One copy is sent to the state regulatory agency after the prescription is filled. In 1990, a bill was introduced in Congress mandating states to institute a federal triplicate program, but it was defeated.³  During the last decade, these programs have increasingly been replaced by electronic variations. Electronic prescription drug monitoring programs require pharmacists to transmit prescription information via computer to the designated state agency.⁴  Table 2 illustrates state prescription drug monitoring programs.

Table 2.  STATES THAT HAVE PRESCRIPTION MONITORING PROGRAMS
STATE	PROGRAM TYPE	SCHEDULES COVERED	YEAR ENACTED
Alabama	Electronic	C II - V	2004
California	Single-copy serialized/Electronic	C II - V	2005
Hawaii	Electronic	C II - IV	2002
Idaho	Electronic	C II - V	2001
Illinois	Electronic	C II	1999
Indiana	Electronic	C II - V	2004
Kentucky	Electronic	C II - V	1998
Maine	Electronic	C II - IV	2003
Massachusetts	Electronic	C II	1992
Michigan	Electronic	C II - V	2002
Nevada	Electronic	C II - IV	1995
New York	Single-copy, serialized/Electronic (state-issued)	C II, Benzos	1998
Ohio	Electronic	C II - V	2005
Oklahoma	Electronic	C II	1990
Rhode Island	Electronic	C II, III	1997
Tennessee	Electronic	C II - IV	2002
Texas	Single-copy, serialized/Electronic (state-issued)	C II	1997
Utah	Electronic	CII - V	1995
Virginia	Electronic (limited to southwest Virginia)	C II	2002
West Virginia	Electronic	C II - IV	1995
Wyoming	Electronic	C II - IV	2003

Source: Pain and Policy Studies Group, University of Wisconsin Comprehensive Cancer Center, 2005.

Notes:

1.  Current as of 4/21/05; prescription monitoring programs are subject to change.

2.  Does not include Washington State’s triplicate program that is used for disciplinary purposes only.

All programs collect the same information with regard to the prescribing and dispensing of controlled substances. The active programs vary, however, in their objectives, how they are set up and what agency is charged with oversight.⁵  The primary mission of PDMPs is to assist in detecting and preventing prescription drug diversion, although many programs also use the data for education and early intervention.⁶

Implementation and Operating Costs

The costs associated with prescription drug monitoring programs vary from state to state. In 2002, The Government Accountability Office (GAO) evaluated these costs for Kentucky, Nevada and Utah. Table 3 details the implementation and operating costs for these states.

Table 3.  Key Features of Selected State Prescription Drug Monitoring Programs
Key features	Kentucky	Nevada	Utah
Census 2000 population	4.04 million	1.99 million	2.23 million
Year operational	1999	1997	1997
Start-up funding	$415,000 in federal start-up grant funds	$134,000a in state funds	$50,000 in one-time state funds
Controlled substance schedules monitored	II, III, IV, V	II, III, IV	II, III, IV, V
Electronic data collection and reporting	Yes	Yes	Yes
Private contractor receives dispensing information and creates database	Yes	Yes	No
Annual operating costs (estimate)	$500,000	$112,000	$150,000
Staff	Four full-time (one licensed pharmacist investigator, two pharmacy technicians, one data entry operator) and four part-time	One full-time with all administrative duties	Three full-time, including manager and two support  staff
Number of pharmacies reporting dispensing data (estimate)	1,300	387	375
Number of daily data requests received (estimate)	400	20	130 to 150
Report turnaround time to requestor (estimate)	Four hours	Four hours	Three hours
Penalty for unauthorized use or disclosure of PDMP data	Class D felonyb	PDMP statute has no penalty	Third-degree felonyc

Source:  U.S. Government Accountability Office, Prescription Drugs:  State Monitoring Programs Provide Useful Tool to Reduce Diversion, (Washington, D.C.:  GAO, May 2002).

Notes:

a.  Nevada received $265,000 for the first two years of its program’s operations, including two-year grants from two pharmaceutical companies and the state Board of Medical Examiners.

b.  Kentucky law defines a Class D felony as one carrying a sentence of at least one year, but not more than five years in prison.

c.  Utah law defines a third-degree felony as one carrying a sentence of not more than five years in prison.

The three state programs detailed above operate using state funds, but states can offset start-up costs through federal funding. Kentucky, Massachusetts and Oklahoma used federal funds to initiate their PDMPs.⁷  The average start-up cost for a PDMP is $300,000 per state.⁸

Grants are available to begin a program or enhance existing programs. In 2002, nine states were awarded a share of $2 million in federal grant money to address prescription monitoring programs.⁹  The Bureau of Justice Assistance Harold Rogers Prescription Drug Monitoring Program awards these grants to states. The bureau awarded grants for fiscal year 2003 to Alabama, California, Florida, Idaho, Maine, Nevada, New Mexico, New York and Wyoming, three of which will use funds to start a new program. For more information, visit www.ojp.usdoj.gov/BJA/grant/prescripdrugs.html.

State agencies report that PDMPs reduce or eliminate prescription forgery and are useful for detecting doctor shopping and illegal practices by physicians and pharmacists.¹⁰  The GAO agrees. A GAO evaluation of PDMPs found that Kentucky’s program reduced the average investigation time of a doctor shopper from 156 days to only 16 days.¹¹

Opponents of electronic PDMPs claim that collecting this information electronically presents potential privacy and confidentiality issues.¹²  The database is not accessible to the public, however, and can be viewed only by doctors, law enforcement and the state agency charged with oversight.¹³

Another criticism of prescription regulation, be it the Controlled Substances Act (CSA) or a monitoring program, is that it creates a “chilling effect” under which doctors hesitate or cease to prescribe the regulated drugs, which may affect patient care. Some reports have suggested that states with PDMPs have seen 35 percent to 50 percent reductions in the prescribing of regulated controlled substances.¹⁴  The DEA reports, however, that from 1990 to 1998, the overall production of schedules II and III narcotics has steadily increased.¹⁵  In addition, data indicate that overall prescribing and consumption of these drugs have increased, despite the fact that more states collect prescription data.¹⁶

To alleviate any concern about the use of these programs and their effect on sound medical practice, pain and policy studies researchers indicate that certain objectives should be met. These objectives include providing the medical community with exact information as to the purpose of PDMPs; devising clear policies with regard to the management of pain and other debilitating conditions (20 states have adopted model policies advised by the Federation of State Medical Boards); and using data to evaluate prescribing trends and the programs’ effectiveness.¹⁷  Some states have gone further to protect patients and physicians. Kentucky, for example, defines authorized users in the statutes, and misuse of data can result in a felony conviction.¹⁸

Several groups have spoken out on state prescription monitoring programs. The American Alliance of Cancer Pain Initiatives, for example, stated that these programs could be part of a balanced approach to dealing with abuse and diversion of pain medications if:

• A medical review group is involved in developing and evaluating the program;
• The program is administered by a state agency that regulates health care;
• Serialized prescription forms are not used;
• All controlled substances (schedules I to V) are covered;
• Patient confidentiality is protected;
• Health care professionals are educated about the program to alleviate concerns; and
• An evaluation component is included to measure the program’s effect on patients’ needs for the controlled substances.¹⁹

National Prescription Monitoring Program

A recent push at the federal level has occurred to pass the National All Schedules Prescription Electronic Reporting Act (NASPER). Supporters claim that the national program is favorable because:

• The databank would allow physicians nationwide to access patient information to see whether a patient is taking medications prescribed by another physician;
• Schedule II, III and IV prescriptions would be monitored, allowing for consistent data collection across states;
• The program would be consistent with privacy rules that exist in the current Health Insurance Portability and Accountability Act (HIPPA); and
• Information would be released only to a practitioner or pharmacist who is providing treatment, or to law enforcement personeel when requested based on evidence for cause.²⁰

Proponents of the national program argue that people can cross state lines to access drugs in a state without a PDMP. There is evidence that prescription drug abuse and diversion does increase along the border of states with prescription monitoring programs. This has been evident in the five states bordering Kentucky that do not have monitoring programs.²¹

Advocates of the state-by-state approach claim that a national system is too expensive. State programs, they say, can achieve uniformity by setting minimum standards with the help of organizations such as the National Alliance on Model State Drug Laws.²²

Regardless of the method used to monitor prescriptions, successful control of prescription drug diversion also may involve educating prescribers about drug diversion and abuse.

Notes

1. U.S. General Accounting Office, Prescription Drugs: OxyContin Abuse and Diversion (Washington, D.C.: GAO, 2003), 15.
2. Ibid.
3. Bonnie Wilford et al., “An Overview of Prescription Drug Misuse and Abuse: Defining the Problem and Seeking Solutions,” Journal of Law, Medicine & Ethics 22 (Fall 1994): 201.
4. Ibid.
5. U.S. General Accounting Office, Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion (GAO Publication No. GAO-02-634) (Washington, D.C.:  GAO, May 2002), 3.
6. David Joranson et al., “Pain Management and Prescription Monitoring,” Journal of Pain and Symptom Management 23 (March 2002): 233.
7. U.S. General Accounting Office, Prescription Drugs: State Monitoring Programs, 21.
8. The Office of National Drug Control Policy, National Drug Control Strategy Update (Washington, D.C.:  ONDCP, March 2004), 28.
9. “Funding Approved to Start New Prescription Monitoring Program,” The Associated Press State and Local Wire, 29 November 2002, Sec. State and Regional.
10. David Joranson et al., 234.
11. U.S. General Accounting Office, Prescription Drugs: State Monitoring Programs, 3.
12. Anita Kumar, “Database Would Monitor Drug Use,” St. Petersburg Times, 2 May 2002, Sec. A1.
13. Ibid.
14. Edgar H. Adams and Andrea N. Kopstein, “The Nonmedical Use of Prescription Drugs in the United States,” Impact of Prescription Drug Diversion Control Systems on Medical Practice and Patient Care, NIDA Research Monograph 131 (Rockville, MD:  NIH, 1993), 117.
15. U.S. Department of Justice, Drug Enforcement Administration, A Closer Look at State Prescription Monitoring Programs (Washington, D.C.:  U.S. DOJ, April 2000).
16. Ibid.
17. David Joranson et al., 235-236.
18. U.S. General Accounting Office, Prescription Drugs: State Monitoring Programs, 18.
19. Diane Cope, “States Cautioned When Developing Prescription Monitoring Programs,” Clinical Journal of Oncology Nursing 7 (January/February 2003): 19.
20. American Society of Interventional Pain Physicians, “Fact Sheet on the Need for a Federal Prescription Drug Monitoring Database” (Paducah, KY:  ASIPP, 29 December 2003) http://www.nasper.org/FactSheetNasper.htm.
21. Gideon Gill, “Grants Highlight Dispute Over Plan to Track Drugs,” The Courier-Journal, 28 November 2002, Sec. Local.
22. Ibid.

 Back to Main Site

NCSL Home Page