Prescription-Monitoring Programs

The National All Schedules Prescription ElectronicReporting (NASPER) bill has been under considerationin Washington, DC, for the past 2 years. This bill,if passed, would allow for a national database on the dispensingof controlled substances in schedules II-IV. Virtuallyall dispensers of controlled substances in the UnitedStates would be required to report the filling of these drugs.

Currently, less than half of the states in America have anactive prescription-monitoring program. Many of these programsare excellent and provide valuable controlled-substancedata to health professionals and law enforcement. Thebest ones, such as Kentucky's KASPER system (Kentucky AllSchedules Prescription Electronic Reporting), retrieve all controlled-substance information and make it readily available.

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

Also, in order for these programs to work effectively, lawenforcement agencies investigating these types of crimesneed to have ready access to the information. It is importantto remember that, not only are these offenders committingdrug crimes, but also, in many instances, they are using privateor public health care to facilitate their offenses. Not onlyare health care fraud crimes involved, but also these offensesare 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 abusethe system or go on a "fishing expedition." Also, any prescriptionprogram of this type should be controlled andmonitored by a non?law enforcement governmental agency.

Not only are prescription-monitoring programs an obviouslaw enforcement advantage, but they also provide 2 basicadvantages to practitioners. First, practitioners receive timelyprescription-drug information on their patients, which allowsthem to make an informed decision on prescribing controlledsubstances. Second, and equally important, such a programtends to relieve the paranoia that has been associated with theprescribing and dispensing of these essential drugs.

This second advantage should help prescribers and dispensersconcentrate better on providing the right medicationto their patients, and lessen the worries about drug diversionand other crimes. The result will be better patient care andbetter pain management. Of course, prescription-monitoringprograms need to be used by diversion-educated practitionerswho include pain management agreements, urinescreens, pill counts, and sometimes just common sense.

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

My reasoning primarily involves bureaucracy and themistakes that are inevitable as bureaucracy increases.Bureaucracy exists at the state level, but to a lesser degreethan in Washington, DC. Human beings, who make mistakes,or are provided with bogus or faulty information atthe 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 reportsbefore they are disseminated to health professionals or lawenforcement in an attempt to ensure their accuracy. Mistakesand problems exist on the state level. Imagine the incrediblejob of providing accurate information when dispensinginformation is being provided by personnel in 50 states!

I think that the propensity for misinformation becomesmuch higher when a national system is in place. I wouldmuch rather see the funding that would be needed forNASPER distributed to the states to encourage their own prescription-monitoring programs. This funding also wouldrequire that each state make its program compatible andavailable to personnel in neighboring states.

A segment of the population is opposed to any form ofprescription monitoring. These people sit and wait for anopportunity to find violations of privacy, wrongful arrests,or examples of misuse and abuse of the system. Prescription-monitoringprograms are an essential part of effectivelyfighting the drug-diversion problem, while improving thequality of care for legitimate patients. Let us have non?lawenforcement entities, such as pharmacy boards, monitor theprograms at the state level, and preserve them for theupcoming decades.

John Burke, director of the Warren County, Ohio, drugtask force and retired commander of the CincinnatiPolice Pharmaceutical Diversion Squad, is a 32-year veteranof law enforcement. For information, he can bereached by e-mail at burke@choice.net, via the Web sitewww.rxdiversion.com, or by phone at 513-336-0070.