DRUGS STILL A PROBLEM IN SOUTHWEST VIRGINIA

Program To Monitor Prescriptions Is Useful But Has Limitations

A state prescription-monitoring program to catch people who go from doctor
to doctor to get prescriptions for addictive painkillers such as OxyContin
is helping state police catch criminals.

But the drug-abuse problem is still as bad as ever in some Southwest
Virginia counties the program was designed to help, some officials say.

About a year ago, the state started a prescription-drug-monitoring program
that covers 29 counties and 12 independent cities in the region.

Law-enforcement officials still have their hands full with drug-related
crime and overdose deaths.

"We are not proud of our drug problem," said Lee County prosecutor Tammy
McElyea, speaking recently at a state meeting on the
prescription-monitoring program.

"We are still somewhat at a crisis point. . . . We are getting a little bit
better."

One indicator of the severity of the problem is the increase in
drug-related deaths. In 2003, there were 223 drug-related deaths in the
state's western district, up from 101 in 2000 and 67 in 1997, according to
Dr. William Massello, state assistant chief medical examiner for the
district. Among the places particularly hard-hit: Russell County,
population 30,308. The county had nine methadone-related deaths in 2003.

"This is not the place you would expect to find a drug epidemic," said
Massello, who was also at the state meeting.

He said the drug fentanyl, a painkiller that has been around for years, is
one of the latest he is seeing involved in overdose deaths. The drug comes
in a patch form.

"We see deaths with multiple patches," said Massello, who showed images of
a person who had fentanyl patches on both shoulders and the back.

"I guess this is going to be the next wave," he said. "I don't think our
methadone deaths are going to increase. Our fentanyl deaths are going to be
up."

The state's prescription-monitoring program, which was started last
December after the General Assembly approved it in 2002, has gathered more
than 400,000 prescription records and generated about 880 requests for
information.

In the program, information on prescriptions dispensed for certain
addictive painkillers that are controlled drugs is collected and stored in
a central computer database. The state Department of Health Professions has
contracted with Atlantic Associates Inc. of Manchester, N.H., to collect
the information.

Pharmacies are required to submit information on prescriptions for schedule
II controlled substances, which include such drugs as OxyContin, Percocet,
Ritalin, cocaine and methadone.

But organizers admit the program has limitations that affect usefulness.
The program does not cover all of Virginia and provides limited information
compared to similar programs run by other states. Not all doctors, who
could use the database to make sure patients are not getting the same
medications from other physicians, know about the program.

"It's not quite where we hoped it would be," said Ralph Orr, deputy
executive director for the Virginia Board of Pharmacy. Orr, speaking at the
two-day meeting this month in Richmond, said requests have picked up in
recent months.

In addition to doctors, law-enforcement officials and a few others have
access to the data, which can be used to detect peo-ple who "doctor-shop"
to get prescriptions for narcotics that they then resell on the street, and
which can detect doctors who may be writing a lot of narcotics prescriptions.

"We have had people who have had their teeth pulled one at a time to get an
OxyContin prescription," McElyea said.

The problem extends across state lines, she said, and Virginia residents
sometimes travel to Tennessee and Kentucky to see doctors. Because the
states do not share prescription-monitoring information, there is no way to
detect when someone gets prescriptions from across the line.

"Doctor-shopping is the No. 1 way we see prescription drugs hit the street
in our area," McElyea said. "They know the buzz words to tell their doctors."

Virginia State Police were given access to the database earlier this year.

"I use it a lot," said Special Agent Larry Findley, who works in the
drug-diversion unit out of Salem. "I have made several cases using the
prescription-drug-monitoring program."

Findley and others pointed out that the database cannot be used to go
"fishing" for cases - there must be an active investigation under way to
request data on a person.

Findley said in one case a person enrolled in Medicaid filled an OxyContin
prescription for 90 80-milligram pills, paying only a $1 co-pay
out-of-pocket. Those pills on the street could sell for at least $80 each.
Findley used the database to find that the person had gotten a different
doctor in a neighboring county to write a similar prescription.

"He used Medicaid to pay for something he does not need," said Findley, who
said that could be considered Medicaid fraud.

In another case, Findley said he used the database to support a
prescription-forgery case.

"Just recently, I had someone get a prescription and make photocopies of
it," he said. The doctor did not usually write narcotics prescriptions. A
search of the doctor's record in the database turned up about a dozen
forged prescriptions, Findley said.

Without the prescription-monitoring program, Findley said he would have had
to go from pharmacy to pharmacy to try to get information. With the
program, he was able to submit the doctor's name and find the forged
prescriptions.

After alerting a pharmacy to be on the lookout if any additional
prescriptions came in, Findley was able to catch one of the forgers as she
tried to fill a bogus prescription. He thinks the woman, who was charged in
August and whose case is pending, was working in a gang with four others.

State officials are considering a number of options for the program,
including whether it should be continued.

The program was developed as a pilot, is funded by grants and is slated to
expire in 2005 unless the General Assembly votes to extend, said Robert
Nebiker, director of the Virginia Department of Health Professions.

An advisory committee for the program has recommended that it be expanded
statewide; include data from out-of-state pharmacies; include schedule III
and schedule IV drugs; and allow selected other groups to have access to
the data, among other things.

"We will be making a report to the General Assembly because if there is not
some action taken this session, the program expires," Nebiker said.

"There is a national group working on a compact that would allow states to
exchange information," he said. "There are some federal grants out there
that would allow states to enter into cooperative agreements that will fund
some of that."

Findley said that if the database were expanded to include other scheduled
drugs, the drug-diversion unit would probably have more cases than it could
handle.

"Doctor-shopping cases could be a big part of our caseload if we had more
time to work them," he said.