GRANTS HIGHLIGHT DISPUTE OVER PLAN TO TRACK DRUGS

Kentucky and three bordering states are among nine that will share $2
million in federal money this year to enhance or start monitoring programs
to fight abuse of prescription drugs.

The programs will make it harder for abusers in Kentucky and the adjoining
states -- Ohio, West Virginia and Virginia -- to avoid detection by filling
prescriptions at out-of-state pharmacies, said U.S. Rep. Hal Rogers, who
created the federal grant program, which bears his name.

But critics, led by a Kentucky-based group of pain doctors, say the Harold
Rogers Prescription Drug Monitoring Program represents a piecemeal system
that will make it difficult to share data and for physicians in border
areas to identify "doctor shoppers" -- addicts who visit multiple doctors
to get prescriptions for narcotics.

The pain doctors are working with Rogers' Kentucky colleague, U.S. Rep. Ed
Whitfield, who plans to introduce legislation in January to create a
national prescription drug monitoring program modeled on Kentucky's system,
called KASPER.

"If someone is coming and asking for narcotics . . . they may be addicted,
but we don't know," said Dr. Laxmaiah Manchikanti, a Paducah physician who
is president of the American Society of Interventional Pain Physicians.
"They may be getting (drugs) from other physicians, but we don't know." He
said 40 percent of his patients come from Illinois, Indiana, Missouri or
Tennessee.

The Courier-Journal reported last month that despite the 3-year-old KASPER
system, prescription drug abuse was prevalent along Kentucky's borders,
because five of the state's seven neighbors do not monitor sales of
powerful pain-killers such as hydrocodone and OxyContin.

The two states that do monitor drugs -- Indiana and Illinois -- track only
sales of the most addictive, schedule 2 controlled substances, and they
make the information available only for law enforcement -- not to
physicians or pharmacists, as Kentucky does. Nor do they routinely share
information with Kentucky, which collects sales information from pharmacies
on all controlled substances.

Rogers defended his state-by-state approach, saying it will be cheaper and
simpler than a national program operated by a new federal bureaucracy and
that states should be able to design their own systems without a federal
mandate.

"Consider the enormity and complication of what they're proposing," Rogers
said, noting that a national system would have to collect data on 673
million prescriptions a year at 61,000 pharmacies. "Do the math. It would
be prohibitively expensive."

This year's grants, which the Justice Department will officially announce
by the end of the year, will increase to 21 the number of states that track
sales of narcotics, the Kentucky Republican said in an interview this week.

He said he is seeking to put additional money in the department's 2003
spending bill to help many of the remaining states begin monitoring
pharmacy drug sales.

Rogers said he was persuaded that state prescription drug monitoring
programs "are absolutely essential" by testimony at a congressional hearing
he organized last December on the abuse of OxyContin. The Drug Enforcement
Administration reported in February that an analysis of autopsy reports
nationwide showed the medication had been involved in 464 deaths, with
one-fourth in Kentucky and Virginia.

"The problem is acute in my district" in Eastern and Southern Kentucky,
Rogers said. "In my 22 years in Congress, I have not seen anything as
pervasive and destructive."

As the second-ranking member of the subcommittee that writes the Justice
Department's budget, Rogers got $2 million inserted in the spending plan
for the 2002 fiscal year. The money will go to four states seeking to start
programs -- the three adjoining Kentucky plus Pennsylvania -- and to five
states to improve existing programs, he said. In addition to Kentucky,
those states are California, Massachusetts, Nevada and Utah.

Kentucky will use its approximately $240,000 for a pilot program in Harlan
and Perry counties that will enable immediate recording of pharmacy
transactions -- an improvement over KASPER, which now lags about a month
behind on that data. Physicians will fill out barcoded prescriptions, and
pharmacists will scan the prescriptions with an electronic reader before
filling them, said Scott Render, a spokesman for the Governor's Office for
Technology.

The goal is to make it easier to catch doctor-shoppers and prescription
forgers, as well as to reduce errors in filling prescriptions, Render said.
"If this pilot is a success, it will be used as a model to upgrade or
possibly replace the KASPER system," he added.

Rogers said he is working with the U.S. Drug Enforcement Administration and
the National Alliance on Model State Drug Laws, a congressionally funded,
nonprofit organization, on setting minimum standards and goals for future
grant recipients. The idea is to have all states monitor all controlled
substances and have the technical capability to swap data.

Eventually Rogers wants states to work toward having real-time tracking,
like Kentucky's pilot program.

Manchikanti, the Paducah pain doctor, said he welcomes Rogers' initiative
but believes it "will have a very limited effect," because it is not a
uniform program, and there is no assurance that physicians and pharmacists
would have easy access to the data. "Law enforcement can put them in jail,"
he said of abusers, "but physicians, we can prevent it."

Whitfield's legislation would accomplish many of the same things as Rogers
seeks to do, said William Sarraille, a Washington lawyer who is the pain
physician group's general counsel. He said Whitfield's bill would allow
states to opt out of the national system, as long as they share information
with the federal database and allow physicians in other states access to
their data.

Sarraille said the bill has bipartisan support, but Rogers' opposition is a
problem because of his key role on the Justice appropriations panel and his
leadership role on the prescription drug issue.

Manchikanti said Rogers held up the legislation when it was first
introduced this year, although it wasn't introduced until Sept. 30, so it
would have had little time to pass Congress even with Rogers' support.

Sarraille said he is working with Rogers and his aides to try to win him
over to Whitfield's bill. "Congressman Rogers is the only elected official
to have indicated he has some questions," Sarraille said.

Jeff Miles, Whitfield's press secretary, said, "We're hoping that we'll be
able to reach agreement to move this along" next year.

But in this week's interview, Rogers sounded unpersuaded. "The Hal Rogers
system is working," he said. "I really have a problem with a federal
takeover. . . . Mainly it's just not necessary. We can do this much more
cheaply, effectively and quicker with the approach I'm suggesting taking,
rather than with a national bureaucracy that's hard to imagine."