News & Events

State OK’s tool to detect prescription drug abuse

By Stephen Smith, Globe Staff

With a few computer keystrokes, Massachusetts physicians will soon be able to identify patients who travel from clinic to clinic in pursuit of potent prescription drugs that feed lethal addictions.

State health regulators yesterday unanimously approved the new detection system designed to stop “doctor shopping’’ by addicted patients who try to dupe doctors into prescribing narcotics. The practice, specialists said, has fueled a surge in drug-related deaths in Massachusetts, where abuse of painkillers poses a health threat that rivals heroin and other street drugs.

At least 9,000 Massachusetts residents are suspected of engaging in doctor shopping annually, said Alice Bonner, director of the state Bureau of Health Care Safety and Quality. Starting next year, the beefed-up tracking system approved by the Public Health Council — an appointed panel of doctors, consumer advocates, and public health specialists — will allow physicians and pharmacists to review an online database showing previous prescriptions patients had filled for powerful painkillers such as OxyContin.

It has the potential, one specialist in addiction and pain management said, to help physicians better navigate the often murky boundary between legitimate suffering and compulsive craving and make it more likely that patients who are truly in pain get the right care.

“I’ll tell you, it’s tough to know when you’re prescribing opioids or any controlled substance for chronic pain whether you’re doing benefit or harm,’’ said Dr. Daniel Alford, an addiction medicine specialist at Boston University School of Medicine. “The more tools we have to help us to know whether we’re benefiting or harming the patient, the better off we are.’’

Deaths blamed on substance abuse rose dramatically in Massachusetts in the past decade, to more than 600 a year. How many of those deaths involved prescription medications is not known. Some are undoubtedly attributable to addicts injecting heroin and other street-corner narcotics.

But at South Shore Hospital, where Massachusetts Medical Society president Alice Coombs treats patients, doctors are just as likely to encounter someone in the emergency room who has combined a legal narcotic and alcohol to disastrous effect. Studies elsewhere have suggested that prescription medications contribute to more than half of lethal overdoses.

Massachusetts has had a prescription monitoring program since 1992, but it only covers one category of drugs, which includes OxyContin, Percocet, and morphine, and health providers don’t have direct access to its data. When the Department of Public Health detects worrisome patterns, it contacts physicians and, in egregious cases, law enforcement. So far this year, reports on about 45 patients have been sent to 600 physicians and pharmacists.

Under the expanded system, pharmacists will be required to alert the state when they fill prescriptions from a much broader roster of medications that includes pain relievers such as Vicodin and Darvon, as well as steroids.

Also, as in most other states with monitoring systems, the prescription database will now be updated weekly, instead of monthly.

About 9 million orders are written each year for drugs that will fall into the must-report category. Patients or family members fetching a prescription will have to present a driver’s license, passport, or some other form of identification the first time a prescription is filled. ID will not be required for refills, although Bonner said that could change if abuse remains rampant.

Medications for chronic conditions such as high cholesterol, asthma, and diabetes are not on the list.

A specialist in pain management and prescription monitoring cautioned that it will serve little good to collect reams of new information if it sits unused. Dr. Nathaniel Katz, president of the Natick consulting company Analgesic Solutions, said the state and professional societies must encourage doctors and nurse-practitioners to regularly consult patients’ drug histories before jotting down a new prescription.

“In my opinion, every opiod prescription needs to be accompanied by a check of the prescription monitoring program on that patient,’’ Katz said. “Otherwise, it’s like having a rear view mirror in your car and never looking at it.’’

One of the most comprehensive prescription monitoring programs exists in Kentucky, where an epidemic of OxyContin abuse devastated Eastern Kentucky during the late 1990s.

Since doctors first were able to review prescribing records by computer in 2005, use of the system has soared, said David Hopkins, project manager of the system known by the acronym KASPER. By last year, 532,527 reports were accessed, more than twice the frequency in the program’s early months.

“Some pain management physicians will obtain a report for every patient for every visit,’’ Hopkins said. “They will be heavy users of it. Other doctors have told us they only really use it when, in a patient visit, there’s a red flag that goes off.’’

The Kentucky system has remained free of external breaches, Hopkins said, but authorities have identified a handful of episodes when medical workers downloaded a patient’s history for untoward purposes.

“They have pulled reports to get some kind of dirt or background or information on the person to cast aspersions on them as a drug abuser,’’ Hopkins said.

In Massachusetts, authorities will conduct random checks to make sure information isn’t misused, and violators could face substantial fines and other penalties, Bonner said.

The state is spending about $1 million to strengthen prescription monitoring and will commit $400,000 annually to maintain the initiative. Health authorities said they expect the state’s health insurance program for the poor will save $2 million a year by spotting abusers.

“You look at these people, and you see their faces and you hear their stories, and it’s very compelling,’’ Bonner said. “And the million dollars it has cost to get this program up and running is a drop in the bucket compared to the devastation that has been caused.’’

Stephen Smith can be reached at