Indiana Narcotic Tracking Program

[algosdoc]

We have a new instant feedback program that permits physicians to query all narcotic prescriptions received by a patient during the last year if filled anywhere in the state. I have made approximately 20 queries so far and have noted the following:
1. Only one of my 20 patients was engaging in substance abuse by chronically receiving multiple narcotics from multiple providers, then lying about it to us.
2. A few people I strongly suspected of substance abuse on the basis of multiple provider scripts for narcotics were clean.
3. The system has helped me eliminate 2 potential new patients before even seeing them
4. The system puts out alerts of drug diversion and doctor shopping to all pain physicians for individuals known to be engaging in such.
5. The system is rapid in response and very user friendly

I suspect this system will have multiple effects:
1. reduce substance abuse for prescription drugs
2. reduce drug diversion
3. will make it very difficult for anyone that is engaging in substance abuse through multiple prescribers or massive quantity acquisition to ever find pain management physicians again in the state...

The jury is still out on the overall effectiveness of the program

[Pharmacist.steve]

We have a new instant feedback program that permits physicians to query all narcotic prescriptions received by a patient during the last year if filled anywhere in the state. I have made approximately 20 queries so far and have noted the following:
1. Only one of my 20 patients was engaging in substance abuse by chronically receiving multiple narcotics from multiple providers, then lying about it to us.
2. A few people I strongly suspected of substance abuse on the basis of multiple provider scripts for narcotics were clean.
3. The system has helped me eliminate 2 potential new patients before even seeing them
4. The system puts out alerts of drug diversion and doctor shopping to all pain physicians for individuals known to be engaging in such.
5. The system is rapid in response and very user friendly

I suspect this system will have multiple effects:
1. reduce substance abuse for prescription drugs
2. reduce drug diversion
3. will make it very difficult for anyone that is engaging in substance abuse through multiple prescribers or massive quantity acquisition to ever find pain management physicians again in the state...

The jury is still out on the overall effectiveness of the program

http://www.ssa.gov/employer/ssnv.htm

This website will allow you to verify SSN numbers .. if you get them from patients.. if they give you a bogus SSN .. what else are they lying about??

[Mark N]

Hopefully this system will work on reducing the misuse of our meds without creating obstacles for the legitimate pain patients. I have thought a database like this has been needed to avoid people that used more than one doctor and pharmacy.

[Pharmacist.steve]

Hopefully this system will work on reducing the misuse of our meds without creating obstacles for the legitimate pain patients. I have thought a database like this has been needed to avoid people that used more than one doctor and pharmacy.

Kentucky had the first such data base and I have yet to find a pharmacy that I have worked in ... are interested in using it. some don't even know what the store's login or password is .. apparently the pharmacist that set it up ... had left and no one carried on using it...

[algosdoc]

Indiana unfortunately does not use SSN in their database.
It appears that it will be primarily useful to physicians to stop doctor shoppers. What is surprising to me about the system is how simple it is to access the information instaneously. Pharmacies here have been primed for years in data input since a predecessor program for law enforcement, INSTEP, required all pharmacies to enter Schedule II and III data on patients for the past several years.

[BrokenBladder]

I guess I'm a little slow. I thought all states had this system already in place. I live in Florida and was always told that pharmacies track scripts through the computer to make sure that everyone was getting only one prescription of a certain med. Is this system really not used that much? If not, I think it should be mandated in every state and that might help with the abuse issue.

[algosdoc]

No, it is not in every state, and the level of access varies from one state to another. A law passed well over a year ago, initially titled NASPER, that would have computerized all scheduled drug scripts into a national database eventually devolved into a small federal grant to each state that would independently develop their own programs and have to comply with some strict federal regulations. Some of the states went out on their own and effectively told the US Gov to take a hike, and developed their own programs. Indiana's program is one example. In order to qualify for the small federal grant, the state program must be linked to another state's program, but of course you can see how difficult it would be to link independently developed programs together using different data inputs and different databases. Also, the US Gov wanted to be able to bring in agents from the federal bureaus to do witch hunts on physicians prescribing and to look at individual patients receiving these drugs. Independent minded states such as Nevada said "no way" and did their own program....
The patient I caught in lying to us (using the INSPECT system) about receiving narcotics from multiple providers had all narcotics cut off from all sources. She committed a felony, therefore we are not obligated to continue prescribing any narcotics, regardless of the level of pain or the degree of withdrawal from these medications. She did however receive clonidine for controlling blood pressure and pulse during the withdrawal period.

[Diandra]

Hopefully this system will work on reducing the misuse of our meds without creating obstacles for the legitimate pain patients. I have thought a database like this has been needed to avoid people that used more than one doctor and pharmacy.

Hi Mark,
Please don't take this wrong.
I don't think you meant to sound so judgemental with your statement but, your statement makes legitmate pain patients sound like they are criminals. I have used more than one doctor and one pharmacy yet I am not a drug abuser, nor do I jump from one doctor to the next looking for drugs. There were very legimate reasons for it. Your idea of a database would flag me, a legitmate patient, because I used more than one of each. That almost sounds like it is getting to the point of hysteria.

Diandra

[algosdoc]

Diandra, the databases have the dates of the prescription refills, amounts, prescribers, etc. listed. Doctor shopping is not considered changing physicians or pharmacies but is a pattern of multiple narcotic prescriptions from multiple doctors, each without the knowledge or approval of the other doctors. The database will demonstrate a correlation between patients that change docs and the prescriptions they wrote, and would vindicate patients that by choice or otherwise, elect to change docs. That being said, if a patient had 7 different doctors each in different practice, prescribing narcotics for chronic pain over a years period, then that would raise questions that would need to be answered by the patient.

[Kira]

Heh, I have MORE than 7 different doctors... but only one pain doc :)

My doctors are all different specialists is all (internist, local metabolic/genetics doc, other metabolic doc, neuromuscular, pain/PM&R, cardiology, nephrology, psychiatry, ophthalmology, allergy/immunology, ENT, and now gastroenterology... plus physical therapist, metabolic nutritionist, metabolic genetic counselor, cancer genetic counselor, and therapist).

No doctor shopping... just way too many things wrong with my body. Oh well.

[Mark N]

Diandra, sorry if you were feeling that you would be targeted. I said I hoped that legitimate pain patients wouldn't have obstacles talking about people like us. There are reasons for different doctors and pharmacies I was trying to describe people that get the same script from more than one doctor and use different pharmacies to hide the multiple scrips they have received.

I have gone out of my way to be sure I open about my meds and not create any question about my meds because we are all hurt by people that abuse the system. I have gotten my prescriptions from more than one doctor too but use my PCP to write all my scripts. I use the pharmacy in Indy where my doctor is but also use the pharmacy at home. I use the same national pharmacy in both locations though so I am on their system and can verify when I have filled my scripts.

Once again sorry if you felt targeted because that wasn't what I was talking about. I was talking about people that abuse our system and put our ability to received our needed meds.

[Pike]

I hope the new law gives Drs the confidence to treat people in need … no profession should require a worker to fear loosing a lot or possibly everything when they are doing their honest best …

I do not understand why it took so long to empower Drs to protect themselves ...

Pike

[Pharmacist.steve]

I hope the new law gives Drs the confidence to treat people in need … no profession should require a worker to fear loosing a lot or possibly everything when they are doing their honest best …

I do not understand why it took so long to empower Drs to protect themselves ...

Pike

Indiana started collecting data back in the early 90's BUT only law enforcement had access to it - by law!!... The law was changed this year that allows heathcare professional to have access... as of July 1st.. Law enforcement is only interest in ARRESTING PEOPLE .. I think that some sense of reality has been reached that it might be more effective to stop shoppers/abuser from getting the meds rather than the write/fill/chase/arrest mentality that existed.

[algosdoc]

Steve, I believe you are correct. I spoke with the state pharm board yesterday and they told me after one month of operation, the program has more physicians signed up than they have ever had in law enforcement membership. The numbers will rapidly increase....
We the physicians have zero interest in arresting people nor in having them arrested. Our interests are in control the symptoms of pain and in maintaining a good clean medical practice....

[shotspine]

I know that political issues run rampant in our so-called War on Drugs. BUT....why isn't this a national mandated system? Is there anyone pushing a bill for this? Simple? Probably not! Sure would put a huge dent in the illegal RX traffic, or NOT?

[Pharmacist.steve]

Steve, I believe you are correct. I spoke with the state pharm board yesterday and they told me after one month of operation, the program has more physicians signed up than they have ever had in law enforcement membership. The numbers will rapidly increase....
We the physicians have zero interest in arresting people nor in having them arrested. Our interests are in control the symptoms of pain and in maintaining a good clean medical practice....

I hope that you are right... I have been temping in Louisville which has had KASPER available for several years... I have yet to find a store that knows their login for KASPER.. I finally talked KASPER in giving me a individual login - which they normally only give pharmacies - because I move from store to store.

Yesterday... was working for the first time at a independent apothecary and they had another pharmacist on a previous day that was uncomfortable about one of their "regulars".. but no one knew how to login... SO I ran a KASPER on this person .. suspicions were confirmed .. but this person was not doctor shopping but having Rxs filled from same doc at multiple stores.

I called the doc's office and ask to speak to his assistant/nurse .. couldn't get past the receptionist .. she took down the info ... seemed very unconcerned about the information - like a total of 270 Xanax 2mg on three different Rxs in about ONE WEEK... along with a bunch of opiates... getting what was prescribed as a 30 day supply - about weekly...

To me, it was obvious that this multi-doc practice does not routinely use - or have bothered to sign up for - KASPER

I contacted the Pharmacist at the other pharmacy - NATIONAL CHAIN and suggested that they run a KASPER on this person .. they didn't have the ability to do it... so I faxed them my copy...

I talked to the head tech and asked .. should we call the Jefferson Co drug squad and her reply was that they have been told previously that they are so over whelmed with information ... that to send it to them and they will look into it WHEN THEY HAVE TIME...

AT BEST .. I think that the jury is still out on how much good these databases will provide the chronic pain patients

I left the report with the head tech to give to the PIC (Pharmacist in Charge) and let her deal with it.

Indiana just changed the requirements that pharmacies have to submit INSPECT data every week ... previously .. I believe it was twice a month ... KASPER data seems to be two weeks back.

[algosdoc]

It does make one wonder if the physician writing these scripts for such massive amounts of xanax is getting some as a kickback/bribe....
Eventually the physician himself may be in trouble with the state medical board or the DEA...