CAROLINAS CONSIDER MONITORS FOR DRUGS

OxyContin Abuse Prompts Both States To Seek Closer Scrutiny

Several N.C. lawmakers and the head of the N.C. Department of Health and
Human Services say the state needs a prescription drug monitoring program
to reduce the abuse of prescription drugs such as OxyContin.

Lawmakers in both North Carolina and South Carolina say they're interested
in starting a program. Such programs are helping reduce prescription drug
abuse in some other states. But Carolinas officials say they're hesitant to
start any new initiatives during a year when they're cutting jobs and
programs to balance a $1.5 billion revenue shortfall.

N.C. Secretary of Health and Human Services Carmen Hooker Odom said she's
examining how to set up a monitoring program. But, she said, "The question
is, does the General Assembly say this is a top priority and will it
mandate that you do it and give you the money, or not give you the money?"

Seventeen states use a computer database to flag patients who visit
different doctors or pharmacies for the same drug, or get suspicious
amounts of it.

"There should be ... a system that's in place that can trigger bells and
whistles and red flags when there seems to be an inappropriate use of a
drug," said Sen. Fountain Odom, D-Mecklenburg, who is married to Hooker
Odom. But he said a proposal for a program launched during the budget
crisis would be shot down because of the state's rocky finances.

S.C. Attorney General Charlie Condon said he is looking into getting
federal money to start a program. The soonest a bill could be introduced in
either state is January, when both legislatures return.

A program could cost the states little or nothing to start, because the
U.S. Department of Justice has pledged a total of $2 million in grants to
help set up programs. But N.C. lawmakers say they're worried about
maintaining it. It's unclear how much a program would cost, because the
price would depend on several factors, including how much technology the
system would use and whether new staff would be needed to run it.

A Charlotte Observer investigation published in July found that OxyContin
abuse may have caused or contributed to at least 97 overdose deaths in the
Carolinas in 2000 and 2001. In most cases, other drugs or alcohol may have
been involved.

OxyContin, introduced in 1996, is an effective drug for patients with
severe pain because it provides long-lasting, powerful relief without
negative side effects, unlike other prescription narcotics. But abusers
discovered that crushing the tablets disables the drug's patented
time-release formula, releasing 12 hours of narcotic at once.

Law enforcement and the medical community have faced the challenge of how
to crack down on abuse of OxyContin without limiting the supply of the drug
to those who need it.

N.C. Reps. Dan Blue and Robert Hensley proposed starting a monitoring
system last year, but the measure died before coming to a vote in the
General Assembly. Hensley said it failed because of some lawmakers'
concerns that a program would unfairly burden small pharmacies that don't
have enough workers to keep track of patients' records and report them to
the state.

"The impetus for it was the OxyContin problem," Hensley said.

Bill Purcell, a doctor who chairs the N.C. Senate Health Committee, is
concerned about rapidly increasing health-care costs and says a monitoring
program could keep Medicaid costs down by catching abusers.

North Carolina's Medicaid program is already tackling the expensive problem
of prescription drug abuse by Medicaid patients. Since March, doctors must
get permission from the state before prescribing OxyContin and other widely
abused drugs to a Medicaid patient. The number of OxyContin prescriptions
paid for by Medicaid has dropped 30 percent.

The maker of OxyContin, Conn.-based Purdue Pharma, supports a prescription
drug monitoring program. It has successfully lobbied for the program in
other states in recent years.

Purdue's senior medical director, J. David Haddox, suggests a program:

. Be administered by state health officials instead of law enforcement.

. Monitor all controlled drugs.

. Take pains to protect patient confidentiality.

. Allow law enforcement officials access only if they have the name of a
specific person they're investigating.

Critics say the responsibility to update the system would fall on busy
pharmacists, and would be impossible for small pharmacies with small staffs
and little technology.

"Mom and pop operations struggle as it is ... and, ultimately, they're the
ones who are going to be responsible," said Rep. Wilma Sherrill,
R-Buncombe, who has spoken out against a prescription monitoring program.

Hensley and other proponents argue that all pharmacies have access to
computers and it would not require much time or resources to contribute
information for a monitoring system.

In South Carolina, Rep. Tracy Edge, R-Horry, said cutting down on fake
Medicaid claims is a powerful argument: "Number one, it would help with
fraud at the state level. Number two, it would save people who would
otherwise get addicted."

But S.C. Rep. Joe Brown, chairman of the Medical, Military, Public and
Municipal Affairs committee, said he's heard no talk of it among other
lawmakers.

"I definitely think it'd be worthwhile, but I haven't given much thought to
it," Brown said.

In March, U.S. Drug Enforcement Administration head Asa Hutchinson asked
state attorneys general to consider starting prescription monitoring
programs in their states.

Condon, the S.C. attorney general, said he's looking for ways to start a
monitoring program through the state's Department of Health and
Environmental Control.

"State governments need to have in place long-range plans to deal with
problems" relating to the abuse of prescription drugs, Condon said.

Loy Ingold, special agent in charge of the N.C. State Bureau of
Investigation's statewide diversion and environmental crimes unit, said a
prescription monitoring program "is much needed in North Carolina," because
it would limit the illegal prescription drug trade and help physicians root
out patients who are duping them.

Ingold said his division would take initiative in applying for grants to
start up a program, if lawmakers would support it by passing legislation
creating a program.

Nevada health officials started a program five years ago that has been
touted as one of the nation's best.

Doctors and pharmacists who want information about a patient can fax a
signed letter to the board of pharmacy and days later they are mailed a
list of the doctors the patient has seen and prescriptions the patient
received.

Then it's up to doctors to take action if a patient appears to be "doctor
shopping" by going to many different doctors seeking the same drugs, or
bouncing from pharmacy to pharmacy seeking the same prescription.

Nevada's system also works in another way.

If a patient sees more than 10 doctors, 10 pharmacies, or gets more than
600 doses of a medication (usually pills) in 60 days, the computer system
sends out an alert.

Five years ago, the drug buyers flagged by the computer system filled an
average of 159 prescriptions in 12 months, saw 22 doctors and bought 9,351
pills.

Last year, drug buyers flagged by the monitoring system filled an average
of 54 prescriptions, saw 12 doctors and bought 3,000 pills, indicating that
authorities are able to find violators quicker, before they visit more
doctors and get more pills.

Keith MacDonald, executive secretary to the Nevada State Board of Pharmacy,
said the population that benefits the most from the program is "the doctors
and pharmacists who are being pestered by these people."

Once doctors know patients are abusing the system, "they can cut it off
right away and not be failed or duped by them," MacDonald said.