Prescription-Monitoring Programs

Author: Cmdr John Burke

The National All Schedules Prescription Electronic Reporting (NASPER) bill has been under consideration in Washington, DC, for the past 2 years. This bill, if passed, would allow for a national database on the dispensing of controlled substances in schedules II-IV. Virtually all dispensers of controlled substances in the United States would be required to report the filling of these drugs.

Currently, less than half of the states in America have an active prescription-monitoring program. Many of these programs are excellent and provide valuable controlled-substance data to health professionals and law enforcement. The best ones, such as Kentucky's KASPER system (Kentucky All Schedules Prescription Electronic Reporting), retrieve all controlled-substance information and make it readily available.

Other states have varying degrees of effectiveness; some provide information only on CII drugs, whereas others restrict or refuse to allow access to law enforcement. Although CII drug information is very important, the vast majority of drug-diversion crimes involve CIII and CIV controlled substances. Many times, cost has restricted states from expanding the monitoring system to other controlled substances.

Also, in order for these programs to work effectively, law enforcement agencies investigating these types of crimes need to have ready access to the information. It is important to remember that, not only are these offenders committing drug crimes, but also, in many instances, they are using private or public health care to facilitate their offenses. Not only are health care fraud crimes involved, but also these offenses are helping to drain public health insurance coffers at taxpayers' expense and are driving up private health care costs.

Although law enforcement needs full access to these systems, penalties need to exist for anyone who would abuse the system or go on a "fishing expedition." Also, any prescription program of this type should be controlled and monitored by a non?law enforcement governmental agency.

Not only are prescription-monitoring programs an obvious law enforcement advantage, but they also provide 2 basic advantages to practitioners. First, practitioners receive timely prescription-drug information on their patients, which allows them to make an informed decision on prescribing controlled substances. Second, and equally important, such a program tends to relieve the paranoia that has been associated with the prescribing and dispensing of these essential drugs.

This second advantage should help prescribers and dispensers concentrate better on providing the right medication to their patients, and lessen the worries about drug diversion and other crimes. The result will be better patient care and better pain management. Of course, prescription-monitoring programs need to be used by diversion-educated practitioners who include pain management agreements, urine screens, pill counts, and sometimes just common sense.

So, which program makes more sense and will ultimately be the most effective, the state programs or NASPER? Although I like the components and intent of NASPER, I think that the state programs will eventually provide the better system.

My reasoning primarily involves bureaucracy and the mistakes that are inevitable as bureaucracy increases. Bureaucracy exists at the state level, but to a lesser degree than in Washington, DC. Human beings, who make mistakes, or are provided with bogus or faulty information at the dispensing level, enter the information provided.

When I have talked to those who manage state programs, I have found that pharmacists need to review these reports before they are disseminated to health professionals or law enforcement in an attempt to ensure their accuracy. Mistakes and problems exist on the state level. Imagine the incredible job of providing accurate information when dispensing information is being provided by personnel in 50 states!

I think that the propensity for misinformation becomes much higher when a national system is in place. I would much rather see the funding that would be needed for NASPER distributed to the states to encourage their own prescription-monitoring programs. This funding also would require that each state make its program compatible and available to personnel in neighboring states.

A segment of the population is opposed to any form of prescription monitoring. These people sit and wait for an opportunity to find violations of privacy, wrongful arrests, or examples of misuse and abuse of the system. Prescription-monitoring programs are an essential part of effectively fighting the drug-diversion problem, while improving the quality of care for legitimate patients. Let us have non?law enforcement entities, such as pharmacy boards, monitor the programs at the state level, and preserve them for the upcoming decades.

John Burke, director of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 32-year veteran of law enforcement. For information, he can be reached by e-mail at burke@choice.net, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.