Doctors and pharmacists are beginning to use a once-ignored state program to better identify drug-seeking addicts, according to speakers at the Madison County Heroin Task Force meeting Thursday.
Dr. Randy Malan is clinical director of the Illinois Prescription Monitoring Program, a voluntary program to catalogue narcotic prescriptions across the state and warn doctors when a patient is seeking drugs — and to warn others when doctors are over-prescribing.
Malan said at the program’s inception, the data arrived on pieces of paper and workers manually entered them, often six months behind schedule. Only about 50 percent of all prescribers of narcotic-level drugs were even licensed to do so, mostly because they didn’t want the oversight hassles, he said. Every 30 days another raft of paper prescription copies would arrive, and they would enterthem into the system.
Back then, they might average 12 law enforcement requests for information per year, with perhaps one successful prosecution of a doctor who was over-prescribing, he said. “What we had accomplished was an impediment to good, active clinical care,” Malan said.
So the IPMP created a computer database that doctors and other prescribing professionals could log into and provide their own information. They reached out to every clinical organization that was authorized to prescribe. The database is now available to many more doctors, so an emergency-room doctor can find out if a patient complaining of pain is actually a habitual drug seeker who has already gotten a narcotic prescription from another source.
The biggest drug-seeker identified by the program? One patient had used 63 prescribers and 58 dispensaries to fill prescriptions, mostly paid for by third parties, Malan said.
The expansion coincided with the explosion of opiate-type prescriptions in the U.S., Malan said. From 1999 to 2010, opiod prescriptions quadrupled across the country - in Illinois, only 43 percent increase, well below the national average, he said. Illinois is actually the lowest rate in the nation for issuing high-level opoid prescriptions.
But fatal poisonings have increased sixfold in the past three decades nationally, and nonfatal overdoses in emergency-room visits doubled from 2004 to 2008 alone. While less than 10 percent of Illinois’ population lives south of I-70, that area comprises 25 percent of the Schedule II narcotic prescriptions.
In Madison County, the current total stands at 37 overdose deaths in 2015 so far, according to State’s Attorney Tom Gibbons, who organized the Heroin Task Force. Of those, 20 were heroin overdoses and 16 were prescription drugs, Gibbons said. “This is the root of the evil we are trying to fight,” he said.
Malan said the over-prescribing of opioid drugs is “a complex phenomenon” that includes the doctor, the pharmacist and the patient. It’s often an individual who is legitimately injured or ill and is put on the drugs, but becomes addicted to it, continuing to use it after the pain has abated.
“Unfortunately based on modern marketing, we are inundated with the message that if I ache of have discomfort of any kind, I should take medication,” Malan said. “We have to reeducate the general population, and have a very healthy respect for what pharmacology can do, beneficially and adversely.”
Now the IPMP sees 13 million searches for 18 million prescriptions per year, and is tied into databases in other states identifying drug seekers going from state to state. The number of registered uses has risen from almost none in 2008 to 28,000, growing at about 200 users per month. And in 2012 to 2013, there was a reduction of nearly 15,000 Schedule II narcotic prescriptions in Illinois, Malan said. However, that number jumped back up in 2014 when oxycodone was reclassified as a Schedule II narcotic.
In addition, professional organizations have begun requiring their members to use programs like the IPMP and to undergo training on pain management and addiction prevention, while some large pharmacy chains also have mandated that doctors participate in the program in order for them to accept prescriptions.
Malan said Illinois spends about $600,000 a year on the program, while Kentucky spends nearly $3 million a year and has far less promising results. He credits technology with helping them make participation easier for doctors, dentists, optometrists and others who are allowed to prescribe. Even after automation, the prescriber had to remember yet another login and password, and it could take up to three minutes from beginning to log in to being able to enter the information.
So they launched a pilot program at Anderson Hospital, linking the hospital’s electronic records directly with the IPMP database. Previously, Anderson’s emergency room and clinics had an average of 207 searches per month. Now they average 5,344 searches per month.
Malan said the Anderson project was so successful that they are reaching out to pharmacies and nine other hospitals to try to link them together electronically. “We believe it will significantly improve compliance,” he said.
The Heroin Task Force has been meeting for about a year and a half, bringing in speakers on issues relating to the heroin epidemic in Madison County and the region in the hope of finding further solutions. Malan said he is hopeful that House Bill 1 will help: It would increase training programs for law enforcement and the general public, require dispensers to report their prescriptions daily rather than weekly, and other aspects he said would assist efforts. The bill has passed the state House and Senate, but has not yet been signed into law, he said.