Washington, DC, USA. In the past decade, prescription drug abuse has soared to new levels. A recent White House study found a 400 percent increase in abuse from 1998 to 2008. Other experts cite the doubling of prescription drug-related emergency room visits from 2004 to 2008.

And the problem continues to escalate nationally, despite prescription drug monitoring programs already running in 33 states. Meanwhile, nine other states have passed legislation to establish such programs, but because of budget problems, they can’t find the money to get them started, according to the National Alliance for Model State Drug Laws.

Florida, which has a county some label as the “painkiller capital of the nation,” may provide the most acute example of the challenges states face. It took three tries, but last fall the state legislature finally passed a bill establishing a monitoring program to start operating this December. The $1 million to get the program up and running, however, is not in the budget.

Paul Sloan, executive director of the Florida Society of Pain Management Providers, lobbied hard for the bill, but says he’s disappointed with the result. Apart from the lack of money, he argues that the “interventionist” side of the pain management industry — the side that treats pain with techniques like acupuncture — crowded the bill with its interests. These include requiring new doctors that prescribe pain medication to be certified in pain management. Sloan’s problem is that Florida has only seven facilities that can offer doctors this certification.

“There are only 250 board-certified doctors and we have 18 million people,” he says, adding that more than half of the state’s population visits doctors every year for pain problems. “This is not a state where 250 doctors can prescribe that.” He also pointed out that many doctors not certified in pain management, such as orthopedics doctors and neurologists, also manage pain.

The real problem that a statewide monitoring program can prevent, Sloan says, is “doctor shopping” — when patients get multiple prescriptions by going from doctor to doctor. “All these people that are dying bought or stole these,” he says. “They’re not dying because a doctor says, ‘Here are 250 Oxycontins, go home and eat them.’ ”

But Washington State lawmakers aimed squarely at how medical doctors prescribe medicine this year by passing the toughest set of regulations yet.

State Representative James Moeller, who is also a chemical dependency counselor, says the increasing amount of prescription drug addiction he saw prompted him to draft the legislation with the help of two doctors, Alex Cahana and Gary Franklin.

Moeller attributes much of the addiction he encountered to doctors over-prescribing painkillers to treat temporary problems like strained leg muscles.

“I had gone in to get my teeth worked on and the dentist gave me a 30-day prescription of Vicodin,” Moeller says. “I don’t need Vicodin for 30 days. I don’t even need it for one. I could’ve probably gotten by just using Tylenol.”

The new law requires doctors to refer patients who are using increasingly more prescription drugs and aren’t improving to a pain management specialist for other treatment options. The specialist, for instance, could recommend physical therapy, if appropriate.

The law also orders a panel of doctors, nurses and regulators to determine caps for prescribed dosages by next June. Cancer patients are exempt. Washington State’s next challenge may lie in tapping into the limited number of pain specialists to whom patients will be referred.

“Next logical step”

State Senator Evan Jenkins, executive director of the West Virginia State Medical Association, acknowledges the complex policy challenge of defining the “good use” and “bad use” of legally prescribed drugs. “This is so different in many respects to the War on Drugs we grew up on,” he says. Jenkins cosponsored four sweeping bills signed by Governor Joe Manchin in July that tightened regulation of prescription drugs. One provision made West Virginia the first state to require pharmacies to provide their workers Internet access to the state’s prescription drug monitoring database. Small pharmacies already allowed this, but it was the big chains, namely CVS and Rite Aid, that restricted access.

Many, including Jenkins, say the next logical step is to share monitoring information across state lines. Kansas state Senator Vicki Schmidt, herself a pharmacist, chaired an advisory panel last fall with lawmakers and administrators of monitoring programs to come up with an interstate compact addressing the situation. It promises to lay out rules that participating states would agree to follow when sharing databases.

Once a proposal is ready sometime next month, then state legislatures can adopt the compact during their 2011 legislative sessions. States without monitoring programs can join as soon as a program is set in place. The goal is to eventually include all 50 states.

Still, many say that successfully monitoring prescription drugs has a long way to go. John Burke, a former police commander and president of the National Association of Drug Diversion Investigators, says that law enforcement has been slow to address the problem — it was prevalent when he was working the Cincinnati streets in the 1970s. One solution rarely discussed would be requiring prescription drug purchasers to provide photo IDs.

Jenkins says if solutions are not found soon, the problem will only get worse. “This issue is not going to be solved by law enforcement alone, nor addiction treatment alone,” Jenkins says. “[It’s] going to take everybody working together with a large pool of resources.”

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy. TS-Si thanks The Pew Charitable Trusts for its support and cooperation.

Stateline reports are prepared and published by TS-Si.org with permission. Signed articles do not necessarily convey an official position of TS-Si, its partners, or affiliates.

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