NEW LAW SETS UP PRESCRIPTION DRUG DATABASE

Whether a database to allow the state to keep track of all controlled
substance prescriptions filled in Tennessee will work remains to be seen,
but area pharmacists say the new law is on the right track.

Doctors and pharmacists have known for some time that people abuse
prescriptions, either to feed their own drug habit or to get drugs to sell
on the street. But there never has been any way to keep track of it.

On Jan. 1 the Controlled Substances Monitoring Act initially took effect in
an effort to change that. The act will set up a data-base to compile every
pre-scription for a specific list of drugs, many of them painkillers,
filled in the state by pharmacists, doctors and even veterinarians.

It will establish a committee to check the data for trends -to identify one
person filling numerous prescriptions for the same or similar drugs, for
instance - and will empower the committee to relay that information to the
proper medical authorities and, if necessary, to the proper law enforcement
agency.

Baeteena Black, executive director of the Tennessee Pharmacists
Association, summed up a main reason why the General Assembly passed the law.

"The information will, hopefully, be used to detect any patterns of abuse,"
she said last week. "It will assist in notifying prescribers and dispensers
of drugs of particular patients with problems.

"We hope ultimately to be able to identify patients early on and prevent
them from getting into an abusing situa-tion."

Charles McBride, a pharmacist at Tullahoma Drug Store, said the database
law is a good idea.

"I've been looking forward to something like this for the past 30 years,"
he said. "The big reason is patients can go to different doctors and get
pre-scriptions filled at different stores."

McBride said such uncontrolled conditions could have allowed for
potentially high abuse patterns."That's been a big problem," he said.
"There's no way to know and no way to track prescription drug sales."This
should have been set up 30 years ago."

Edward Cribb, Tullahoma Walgreen Drug Store pharmacy manager, echoed
McBride's statements.

"I would agree," he said, referring to McBride's assessment about how a
prescription drug database is needed. However, Cribb said privacy issues
need to be considered.

"We need to see how it's going to work," he said. "We need to see whether
it will infringe on confidentiality. "That has to be a concern any time you
fill a prescription. Pharmacists always stress confidentiality. "Cribb said
the process to implement the database needs to be properly monitored to
ensure patients receive the confidentiality they are entitled to.

Ms. Black said though the law took effect on Jan. 1, the database will
probably not see statewide operation until late this year or in early 2004.

She said the Tennessee Board of Pharmacy will be monitoring the database as
it is set up in the coming months and will be ironing out problems as they
occur.

"Privacy is definitely not an issue," Ms. Black said, adding that the
database will be "crafted to protect individual privacy rights.

"There will be a very deliberate process to make sure people's privacy is
protected."

Ms. Black said statewide prescription drug databases are nothing new.

"It's been done in 15 states," she said, adding that Tennessee will have as
many opportunities to monitor to ensure its system works properly.

She said Tennessee's program was patterned after one in Nevada, the first
state to implement a prescription drug database.

Rep. David Shepard, D-Dickson, a pharmacist who sponsored the bill in the
House, said the idea of tracking prescriptions arose because Tennessee has
an abnormally high use of hydrocodone, a synthetic narcotic marketed under
the brand names Vicodin and Loratab, among others.

"We know there are people filling these for resale or to feed an
addiction," Shepard said. "We'd like to find out who they are."

"States that have implemented similar laws have seen a 45 percent reduction
in drug diversion (resale)."

Ms. Black said no one is sure how big a problem the abuse of legally
prescribed drugs is in Tennessee, partly because so little data has been
available. However, it is bound to be big, she added.

"We think it's a substantial problem or we wouldn't have gone to all this
effort," she said, adding that the bill was in the works for four years in
the Legislature before being approved last summer. "It's a substantial
problem in every state, not just here."

She said many abusers of prescription drugs begin le-gitimately, but they
build up a tolerance which eventually lead to physical and psychological
addiction.

The program is being funded through fees paid by pharmacists and other drug
dispensers, Ms. Black said. Since the database will contain sensitive
personal information, deciding who has access to it was a critical aspect
of the legislative debate.

Kendall Lynch, director of the state Board of Pharmacy, provided the state
board's perspective.

"We're writing the rules now for who has access, how the information can be
disseminated, what data are ac cumulated," Lynch said.

The Board of Pharmacy is the keeper of the database. Lynch and two board
members are on the 14-member committee that oversees it.

The biggest debate in the Legislature was over how much access law
enforcement officials should have to the data. A compromise was reached,
but proponents of the law insist that was a side issue.

"This is health care legislation," Lynch said. "You can treat people for
addiction for $3,000 a year, but if you throw them in jail it'll cost you
$30,000 a year."Lynch traced the origins of the monitoring act to about
four years ago, when a federal report suggested Tennessee had a high
percapita usage of controlled substances, par-ticularly hydrocodone.

"The Board of Medical Examiners formed a committee to look into that, and
invited us, law enforcement and some others to participate," Lynch said.
"What became clear to us was, there wasn't any reliable data for us to make
any deci-sions about anything."

The act requires a report on the dispensing of a controlled substance
unless it is administered directly, such as in an emergency room; is
dispensed in less than a 48-hour supply; or is dispensed at a methadone clinic.