Prescription For Abuse, Part 2a

PRESCRIPTION-MONITORING SYSTEM HAS GAPS

Few Neighboring States Operate Similar Programs

Harlan County pharmacists were seeing so many OxyContin prescriptions from
Dr. Ali Sawaf two years ago that they stopped filling them.

His patients then went to nearby drugstores in Virginia and Tennessee; one
pharmacist from Big Stone Gap, Va., would later testify that he
occasionally filled 100 Sawaf prescriptions for the powerful painkiller in
a matter of hours.

Sawaf was convicted in January of prescribing the drug without a legitimate
medical purpose. Though he has appealed, he has begun serving a 20-year
sentence, and his medical license has been suspended.

But an investigator in Kentucky Attorney General Ben Chandler's office says
the case was made more complicated because Virginia and Tennessee had no
computer systems to monitor sales of controlled substances.

Kentucky set up an electronic monitoring program, called KASPAR, in 1999,
and ''it's just been a godsend for law enforcement,'' said Mike Duncan,
director of special investigations in the attorney general's office.

The system greatly reduces the time it takes law enforcement to investigate
alleged ''doctor-shopping'' -- when prescription-drug abusers visit
multiple doctors and pharmacies to get narcotics.

But the Sawaf case highlights one of several gaps in the system that hinder
multistate investigations and lessen KASPAR's effectiveness in preventing
addicts from getting painkillers.

Most of the seven states bordering Kentucky do not have prescription-drug
monitoring systems -- so doctor-shoppers can avoid detection by crossing
state lines. That's what investigators allege happened in South Shore, an
Ohio River town in northeastern Kentucky that's a bridge away from Ohio.

Five doctors have been indicted on charges that they unlawfully prescribed
drugs from a clinic in South Shore and other offices they opened nearby,
and investigators say many of its patients came from Ohio and other states.

When an abuser crosses state lines to fill a prescription, ''it's as if the
prescription didn't exist,'' said Mark Caverly, diversion program
supervisor in the federal Drug Enforcement Administration's Louisville
office. ''We had doctors saying exactly that -- don't fill the prescription
in South Shore, take it to Ohio.''

Indiana and Illinois are the only states adjacent to Kentucky that track
sales of controlled substances, but they monitor only the most addictive
drugs, while Kentucky monitors all medications that can be abused. Plus,
the states' systems don't share data.

The legislatures in Tennessee and West Virginia have passed laws to create
monitoring systems, but they are not in operation. A bill is pending in the
Ohio legislature.

Virginia, at the direction of its legislature, is seeking a federal grant
to implement computer monitoring along the Interstate 81 corridor at its
western and southwestern edges, which have experienced the most trouble
with OxyContin trafficking, said Tim Murtaugh, a spokesman for Virginia
Attorney General Jerry Kilgore.

If the pilot project works, the program could be expanded statewide. But
Murtaugh said privacy concerns led the legislature to restrict access to
the system to state police investigators, so it's doubtful the data could
be shared with Kentucky authorities.

Danna Droz, who oversees Kentucky's program as manager of the Drug
Enforcement Branch in the state Public Health Department, said state law
gives only Kentucky and federal law enforcement agencies direct access to
the system's data, though investigators from other states can get it by
working through the DEA or another federal agency.

Caverly said DEA officials in Washington are beginning to discuss a
national monitoring system, and bills to create such a system have been
filed in Congress. But maintaining the privacy of patient information is a
big concern, he said.

Droz cautioned that a national system would be less flexible than KASPAR
and may not track all drugs that a state wants to monitor. ''We have some
problems with some drugs that are not controlled substances,'' she said,
but declined to identify them.

Upgradeis delayed

Physicians, not law enforcement, are the biggest users of KASPAR, and
Kentucky officials are seeking money to enhance the system so that doctors,
and pharmacists, could more quickly and easily identify potential
doctorshoppers.

But the General Assembly's budget impasse has delayed the enhancement,
which would involve buying new equipment and hiring staff.

Doctors and pharmacists now must wait about four hours for a patient's drug
history to be faxed to them, making it impractical for catching and
deterring addicts.

KASPAR's four to five full-time employees have been overwhelmed by requests
for data, which average about 350 a day, said Caverly. ''They are almost a
victim of their own success.''

With the enhanced KASPAR system, the turnaround time would be cut to a
half-hour or less, said Droz. And all controlled-substance sales would be
entered into the database within two weeks of the transaction; pharmacies
now are required to report monthly.

''It would allow the doctor the potential to decide not to prescribe, which
would be a preventive, proactive measure,'' Droz said of the proposed
enhancements. Pharmacists also would be able to decide whether to fill a
prescription, she said.

Both the House and Senate agreed to support the KASPAR upgrade. Gil Lawson,
a Cabinet for Health Services spokesman, said versions of the budget passed
by each chamber included $1.5 million for new computer hardware and
software, to be paid with bonds, and $225,000 for staff to operate the
enhanced system, to be paid for with tobacco settlement money.

But no budget was passed before the start of the state fiscal year on July
1, because the House and Senate disagreed over whether to continue using
taxpayer money to help finance the campaigns of gubernatorial candidates.
The bonds cannot be issued without an approved budget.

Systemaids police

The KASPAR improvements and the move toward ''real-time reporting'' were
among the recommendations made last year by the Governor's
OxyContin/Prescription Drug Abuse Task Force, which Gov. Paul Patton formed
after OxyContin was blamed for dozens of overdose deaths in Eastern
Kentucky since January 2000.

Kentucky lawmakers this year also passed a bill to require the state to
apply for a federal grant to test a realtime electronic monitoring system
for controlled substances in two rural counties.

Aldona Valicenti, who heads the Governor's Office for Technology, said the
state has applied for the Justice Department grant and expects to hear
within the next few weeks whether it will get the money -- about $200,000
over two years -- to set up the program in Harlan and Perry counties.

Caverly said the pilot project would test whether data about pharmacy sales
can be entered into a database as soon as a transaction is completed.

Kentucky is one of 15 states with a prescription drug monitoring program,
and it is one of only two states that collect data on all controlled
substances, according to a May report by the General Accounting Office of
Congress.

Kentucky's system, created in 1999, received 56,367 requests from
physicians last year, 5,797 from law enforcement and 3,961 from
pharmacists, Lawson said. The state credits KASPAR with cutting the average
time it takes to investigate alleged doctor-shoppers from five months to 16
days.

Duncan noted that a 1997 probe of alleged prescription drug abuse in
Whitley County -- undertaken before KASPAR -- took 13 months, because
investigators had to collect 14,000 paper prescriptions from 13 pharmacies
and enter them by hand into a computer spreadsheet. ''We could probably get
that done with KASPAR in a month or two months, because the data is already
there,'' he said.

Caverly said the DEA also uses KASPAR as a screening tool to determine
whether tips about excessive prescribing by physicians merit investigation.

Before KASPAR, he said, investigating doctors ''was just hit and miss.''
Agents had to visit multiple pharmacies, which often had incompatible
databases. ''I can remember sitting in front of a computer myself and just
inputting records from a half-dozen different pharmacies,'' Caverly said.