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Thursday, March 30, 2000
Copyright © Las Vegas Review-Journal
Database monitors pharmacy narcotics
A program to prevent prescription addictions can be accessed by state agencies, but not citizens.
By Jan Moller
By Jan Moller
©2000, Las Vegas Review-Journal
Joanee runs the Nevada Prescription Controlled Substance Abuse Prevention Task Force. Although she works for the state as an employee of the Board of Pharmacy, she won't give a reporter her last name or exact location.
Perhaps it's a good thing Joanee is stingy with information, for she controls a treasure trove of it.
She administers a secret database that records every time a controlled substance is prescribed in Nevada. This database was launched in 1997 with a $50,000 donation from the Nevada Board of Medical Examiners and $180,000 from two drug companies that "prefer to remain anonymous."
The information is not available to the public, but every state agency can gain access to the records by request.
The ostensible purpose of the database is to detect and help people who are abusing prescription drugs -- and to catch doctors who are prescribing too many. Using a set of undisclosed thresholds, the database helps identify people who may be "doctor-shopping," or going to several doctors for prescription narcotics without telling one about the others.
Doctor-shopping is a felony under Nevada law, and so is forging prescriptions or calling in a fraudulent prescription to a pharmacy. But the director of the Pharmacy Board says the program is designed to help abusers -- not punish them.
"No one wants to see someone put in jail" for abusing prescription drugs, said Pharmacy Board Director Keith McDonald. "The goal of the program is to get the doctors and pharmacists to recommend good pain management (for their patients) and to get people off drugs."
McDonald said about 17 other states keep track of controlled-substance prescriptions, but only a handful of them have computerized their systems.
The existence of the database also raises questions about what could happen were the records to fall into the wrong hands.
"As soon as a government agency says, `You don't have to worry about that because we're good guys and you can trust us,' then you know you're in trouble," said Allen Lichtenstein, general counsel for the American Civil Liberties Union of Nevada. "Because then it becomes discretionary, and then it becomes unlimited in what they can do."
Although patients are not told about the database, it appears to be on solid legal ground. Paul Schwartz, a law professor at Brooklyn Law School who has written extensively on health law, said the U.S. Supreme Court tested a similar case in New York in 1976 and found it passed constitutional muster.
"These kinds of statutes -- as long as it spells out how (information is) collected and who it is shared with in some precision -- it's not going to be a constitutional issue."
McDonald said there have been no complaints about the database, and he added there are good reasons for keeping it quiet.
"It (disclosure) might make people afraid to ask for pain medicine, and it may make doctors fearful of writing pain prescriptions," McDonald said. "Then you have some people who just wouldn't like it, who don't want you to have any information about them, including their address or Social Security number."
McDonald added neither of the two drug companies that provided the seed money for the database has asked for -- or received -- access to the information it contains. But while he maintains the information is kept under tight control, the state law authorizing the database is vague on the privacy issue.
Under Nevada Revised Statute 453.1545, the program must provide information about "the inappropriate use by a patient of controlled substances ... to pharmacies, practitioners and appropriate state agencies in order to prevent the improper or illegal use of such controlled substances." Nowhere does the statute say what constitutes an appropriate state agency.
Further down, the statute requires that "the board or division shall report any activity it reasonably suspects may be fraudulent or illegal to the appropriate law enforcement agency or occupational licensing board."
In Nevada, that law enforcement agency is the Nevada Division of Investigation, which has a few investigators working from a nondescript house on South Jones Boulevard. Armed with lengthy printouts of questionable prescriptions, the investigators are charged with patrolling a prescription-drug abuse problem that one describes as "epidemic -- almost to the level of street drugs."
For example, investigators say that last year more than 24 million doses of the narcotic hydrocodone were prescribed in Nevada -- or about 12 such pills for every man, woman and child in the state. Hydrocodone, a pain killer sold under brand names such as Loritab and Vicodin, is by far the most popular prescription narcotic in Nevada.
Information from the database also has been used to assist the federal Drug Enforcement Administration and other out-of-state law-enforcement agencies. Besides the Pharmacy Board, the task force includes the Bureau of Alcohol & Drug Abuse and the state Medicaid program.
Jerry Hafen, a supervisor in the Las Vegas field office of the Division of Investigations, said plenty of users end up in the criminal justice system. "By all means, we take people to jail every day for submitting false or forged prescriptions for controlled substances," Hafen said. "It's become quite a problem."
There are no firm statistics on how many arrests can be credited to the database, but Hafen said many violators are prosecuted in drug court -- where addicts are often given a chance to seek treatment as an alternative to incarceration.
Although not specifically designed to catch overprescribing doctors -- who can obtain a large amount of prescription drugs through wholesalers -- the database has proven useful to investigators in tracking them down.
"We will go to the Pharmacy Board and say, `Who are your top 10 doctors who are prescribing these particular types of drugs?' " Hafen said. "And then we'll look at those docs."
That's not what the task force was designed to do, Joanee said. "This is an intervention task force, not a criminal one," she said.
When Joanee suspects a person is doctor-shopping, the board will send a letter to all the doctors and pharmacists who are prescribing or dispensing drugs to that person. Last year, the board sent out such profiles on 475 patients -- up from 198 the year before and 97 in 1997, the first year of the task force.
In most cases, McDonald said, those letters are enough to reduce the amount of prescription drugs that the patient is receiving.
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