Virginia’s Monitoring Program Fights ‘Doctor Shopping’ for Prescription Drugs

By Laurence Hammack, The Roanoke Times | July 1, 2014

The fidgety patient stood a bit too close to the counter at DownHome Pharmacy in Roanoke, Virginia, and chatted a bit too eagerly.

She had no insurance, she said, and would be paying cash for her prescription for Norco, a powerful painkiller.

It seemed “a little sketchy” to pharmacist Tim Lucas, who keeps a wary eye on those who come to his Botetourt County drugstore to pick up their pain medications.

Lucas decided to run the woman’s name through Virginia’s online prescription monitoring program. He soon found that she had the same prescription from two doctors, and that one had recently been filled at a different pharmacy.

When Lucas suggested that he call the woman’s doctor to clear up any confusion, she took her unfilled prescription and made a hasty exit — supporting his hunch that her need for Norco went beyond the scope of medicine.

Lucas believes the incident, which he recounted in an interview, is just one example of how the state’s prescription monitoring program is working.

Numbers released earlier this month by the Virginia Department of Health Professions, which runs the database, show a decline statewide in the number of patients who visit multiple doctors and pharmacies, at least by one measure.

In a practice known as doctor shopping, drug abusers feign injuries or illnesses — or embellish their existing symptoms — to multiple physicians, accumulating enough painkillers to feed their addictions.

“In the past, we know that Southwest Virginia has had a much higher prevalence of doctor shopping and misuse of pain medications,” said Lucas, who is president of the Roanoke Valley Pharmacists Association.

With the prescription monitoring program and other advances, he said, “I have definitely seen that being curbed.”

According to data collected through the monitoring system from 2010 to 2013, the number of people visiting at least 10 prescribers and 10 pharmacies over a six-month period has declined by 73 percent.

Dr. William Hazel, Virginia’s secretary of health and human resources, said the system is helping to keep potentially addictive pain medication out of the wrong hands.

“I applaud the many health care providers who are taking action to keep their communities safe” by using the system, Hazel said in announcing the data.

But the numbers are relatively small, and some say they don’t see much of a dent in the larger problem.

The 73 percent decrease is based on the 298 patients who used at least 10 prescribers and 10 pharmacies during the first six months of 2010 — a number that declined to 81 by the second half of 2013.

For a system that contains more than 98 million prescription records, that’s a very small slice of data.

Lawrence Findley, a special agent with the drug diversion unit of the Virginia State Police, said doctor shopping remains one of the major ways that drugs meant for home medicine cabinets find their way onto the black market.

“It’s still out there as much as ever,” Findley said.

More than a decade ago, legal and public health officials said prescription drug abuse had reached crisis levels in Southwest Virginia.

The number of fatal overdoses in the region — 185 in 2012, the most recent total available — has for years surpassed totals in the more populous areas of Virginia, according to the state medical examiner’s office.

The monitoring system, which began as a regional pilot program to address the problem, was later expanded to cover all of Virginia.

Prescriptions are entered into the secure database when they are filled at pharmacies, and health care providers have access to a patient’s individual history 24 hours a day. The database also includes access to records from 15 other states with similar programs.

Use of the system is voluntary, and only about 30 percent of the more than 37,000 licensed prescribers in Virginia are registered. Doctors, dentists, physician assistants and other prescribers must be registered before they can check out a patient’s past prescriptions.

About 60 percent of pharmacists in Virginia are registered, according to Ralph Orr, director of the program.

For the system to reach its full potential, Findley said, more prescribers need to use it.

“I don’t know if they don’t think they need to take an active role in this, or it’s not their problem, I don’t know,” he said.

“But it literally starts with them. If they would use the prescription monitoring program more, it would decrease the doctor shopping that’s going on.”

Doctor shopping can happen on a much smaller scale than the 10-physician and 10-pharmacy measure used in the state’s recent analysis, Findley said.

Although it’s difficult to track the effectiveness of the program in greater detail, Orr said there have been several positive developments in recent years.

The number of registered users continues to grow steadily, and last year the system logged 1.3 million requests for information, up from 860,000 the year before. When the system was launched in 2003, there were just 272 requests in the first six months of operation.

Recent changes to state law could further extend the system’s reach.

At its most recent session, the General Assembly voted to require all prescribers to be registered by July 2015. Registration will soon become automatic when prescribers apply for or renew their licenses.

Another new law will require doctors who prescribe opioids and certain other drugs, such as Xanax and Valium, for more than 90 days to first consult the prescription monitoring system.

The highest-volume prescribers of those types of drugs are already using the system at nearly three times the overall 30 percent rate, according to state data.

The numbers also show that while more people are receiving prescriptions for controlled substances — about 2 million last year — the size of their doses has declined.

Some advocates for chronic pain patients have argued that tougher enforcement is making it harder for people to get the medication they need.

But Orr believes the right balance is being struck.

“We don’t have a chilling effect; people are getting what they need,” he said. “But they don’t have as many pills in their medicine cabinets.”

 

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