BOSTON – Massachusetts residents faced a new routine when they pick up certain prescription drugs at the pharmacy on Jan. 1.
Under a law passed last summer they will have to show a driver’s license or another approved ID before the druggist can give them prescriptions ranging from addictive opiates to certain medicines for diarrhea. Their purchases will be recorded in a massive database that will include their names, addresses and the kinds and amount of pills they take.
The goal of the law is to combat the growing problem of prescription drug abuse, particularly among teens and young adults. According to one federal survey Massachusetts ranked 8th among those 18-to-25 who have used drugs not prescribed to them.
The law is similar to legislation passed in 33 states and being initiated in another 10 states. Studies suggest the programs can help combat prescription drug abuse.
But the law has other consequences that play against the national debate about the size and reach of government.
It will require more clerical work for doctors and druggists as the number of prescriptions monitored expands from the current 3.5 million a year to an estimated range of nine to 11 million.
The Department of Public Health will take on expanded responsibilities. A new set of committees will be created to determine policies and practices. Schools may have to develop new drug awareness programs for their students.
The new law also will cost more money, but by how much remains uncertain.
Rep. Harriet Stanley, D-West Newbury, chairwoman on the Joint Committee on Healthcare Financing, says that when the bill was under consideration, the Department of Public Health said the direct costs of the new monitoring system – estimated at between $1.35 million and $1.4 million – would be absorbed by the department.
But the department later requested $528,000 to roll out the programs mandated by the bill.
“This bill is a great example of how costs increase without you realizing. We thought we had a grip, but we have to relook at it this session,” Stanley said.
Stanley said legislators often don’t know the final dimensions of a bill because additional requirements are often added to the legislation as it passes from committee to committee.
That was the case with this bill. the Senate revisions of the bill call for the creation of four separate commissions to determine the feasibility of tamper- proof prescription forms, a post-treatment job training program for drug abusers, a jail diversion program for veterans convicted of non-violent substance abuse offenses and a education program for all middle school and high school students.
The law was updated to catch up with a national trend. In the early nineties, Massachusetts was one of the first states to monitor how doctors were prescribing Schedule II drugs, including amphetamines and opiates.
But Massachusetts fell behind the curve as other states began to monitor a more comprehensive list of drugs, including a class of anti-anxiety medicines known as benzodiazepines, such as Valium and Xanax.
“National data and information from other states suggest that there is a growing problem for medication like benzodiazepines seen in combination with opiods,” said Dr. Alice Bonner, executive director with the state Department of Health’s Bureau of Health Care Safety and Quality. “Death rates are higher when they’re taken together.”
Several legislators, including Rep. Thomas Golden Jr., D-Lowell, Rep. Steven Walsh, D-Lynn, and Christopher Speranzo, D-Pittsfield took up the Department of Public Health’s initiative to expand the system.
“I started to receive phone calls from constituents who were experiencing problems with family members when it came to prescription drugs,” said Golden, who also heard about the problem from his pharmacist wife.
The new law, which some pharmacy chains are already following ahead of the Jan. 1 implementation date, requires reporting on all prescription drugs listed under federal drug Schedules III through V, which include scores of more commonly prescribed drugs.
The new law also speeds the reporting schedule – once a week vs. once a month – with the aim of turning up patients who are “doctor shopping” a term describing patients who seek prescriptions from multiple sources. The tighter monitoring is also meant to look for doctors who may be over prescribing.
All of the information is stored in a database overseen by The Department of Public Health whose job it is to filter the information and look for inconsistencies.
Margaret Clapp, chief of pharmacy at the Massachusetts General Hospital, says the new law triples to quadruples the amount of data collected by the state.
“For us it’s an add on,” said Clapp who doesn’t see any major complications with the expanded reporting requirements she says will allow doctors to “sniff people out” for instances of prescription abuse.
“Now we have a tool to help us,” she said.
Bonner says the new system will allow for a “very important conversation between the pharmacist and physician” to see a pattern of potential abuse.
But there are concerns about the expanded law. Pharmacists fear they will bear the brunt of consumer anger over the new procedures. Doctors wonder how they will use the system. Everyone has questions about privacy.
Clapp anticipates negative reactions from patients who are likely to learn of the law when they find they will need an ID to pick up their prescription at their local pharmacy.
“Fifty percent of patients show up without anything, a wallet etcetera,” Clapp said. “I can see patients getting [angry].”
There are questions about how the database will be used. The health department sends reports to physicians and pharmacists about problem patients and pharmacists will be able to call physicians if they see that a patient has been visiting multiple doctors, or if a physician has been over-prescribing.
But none of this is mandatory. Doctors and pharmacists aren’t required to consult the database.
William Ryder, counsel for the Massachusetts Medical Society says it will be hard for medical practices to use the data.
“If the physicians themselves are the only ones allowed to do it and their staff can’t do it and it takes 40 minutes to find the data, then it’s not going to work,” Ryder said.
The medical association also is concerned about confidentiality, particularly if police can access the information. Ryder worries that patients who take medications for mental health issues are especially vulnerable in that regard.
“There has to be a balance there between looking at data and looking at individual data,” he said.
According the health department regulations access to the database will be limited to “authorized and authenticated individuals.” Law enforcement agencies will be able to request data involving a criminal investigation or prosecution. Such requests will be made to the attorney general, the state police or the U.S. Drug Enforcement Agency.
Golden said federal health care privacy laws create a barrier against intrusion, but concedes there re no absolute guarantees.
“No electronic information is 100 percent safe,” he says.
Despite the questions, Golden sees the extended legislation as an important step that could save lives.
“It’s not going to solve the problem, but it will put a real dent in the overuse and abuse of prescription drugs,” he said.
Editors Note: This story was written by Sarah Favot and Caroline Hailey and reported by Favot, Hailey, Brittany Danielson, Shaunna Gately, Jason Marder, Kevin Schwartz and Sarah Tann.