NATIONAL FEW STATES TRACK PRESCRIPTIONS AS A METHOD TO BAR OVERDOSES

In the mountain coal fields of eastern Kentucky, Sheriff Steve Duff of
Harlan County recently noticed something curious -- people driving to drug
stores in neighboring states to fill prescriptions of a potent painkiller
called OxyContin.

Their reason, Sheriff Duff believes, was to evade a system in Kentucky that
monitors who gets potentially addictive drugs and who prescribes and fills
those prescriptions.

That system, the sheriff says, helped him arrest several dozen people last
year on OxyContin-related charges. More significantly, it helped police
stage Kentucky's biggest ever drug-abuse raid, resulting in the arrest last
February of 252 people in a sweep called Operation Oxyfest.

Public health and law enforcement officials have long argued that such
monitoring can save lives by quickly identifying problem doctors who
over-prescribe narcotics and problem patients who forge prescriptions or
con unsuspecting doctors.

But today, just 15 states have such programs because of decades of lobbying
by drug companies, doctors, pharmacies and more recently, groups pushing
for the greater use of narcotics to control pain. Even in states that
monitor prescriptions, some programs are underfinanced, crippling their
effectiveness.

Federal drug agents say OxyContin played a likely role in the overdose
deaths of at least 296 people since January 2000, in addictions that have
overloaded drug treatment centers and in crimes like thefts at pharmacies
and on the street. Public officials say OxyContin abuse is also costing
taxpayers tens of millions of dollars because so many people who misuse the
drug get it through Medicaid, a government-financed health care program for
the poor.

Law enforcement officials say that if more states had good monitoring
programs they might have been able to crack down on OxyContin abuse before
it claimed so many victims. States with such programs, like New York, have
seen little OxyContin abuse, while many without them, including Florida,
Maine and West Virginia, have been the hardest hit.

Most of the groups that oppose the monitoring of prescriptions argue that
it violates patients' privacy, costs too much or hurts those who really
need the drugs by causing doctors to prescribe fewer and less potent drugs.
But a report by the General Accounting Office in 1992 and a more recent
survey by the Justice Department looked at several of those claims and
could not substantiate them.

Prescription monitoring has long had some powerful opponents.

"Physicians do not want their activities monitored," said Carmen A.
Catizone, executive director of the National Association of Boards of
Pharmacy, which supports monitoring. "Drug companies are also a powerful
lobby. Once a drug is monitored, sales decrease, and the drug companies
don't like that."

OxyContin, made by Purdue Pharma of Stamford, Conn., was originally thought
to be less prone to abuse because its narcotic was locked in a time-release
formula. But abusers found that they could crush the tablet, then swallow,
inhale or inject the powder to give themselves a high as powerful as heroin's.

As a result of OxyContin abuse, there are renewed calls for more
prescription monitoring. At least eight states, including Connecticut, New
Jersey and Florida, are seriously considering it.

Florida, for example, experienced a 40 percent jump in the number of people
who died from drug overdoses in the first six months of this year.
OxyContin is cited as a factor in many of those deaths.

"This system will allow us to monitor prescription shopping and doctor
shopping and any illicit prescribing by doctors," said Gov. Jeb Bush of
Florida, who announced his support for such a system this month.

For years evidence has shown that prescription monitoring works, health
officials say. For example, when New York State began tracking
prescriptions for certain tranquilizers in the late 1980's -- a move
opposed by four drug companies and the state medical society -- emergency
rooms in New York and Buffalo reported 47 percent fewer overdose admissions
involving those drugs.

"We saw a vast drying up of those drugs on the streets," said John Eadie,
the former director of New York's program who now consults with states on
setting up monitoring programs.

But Dr. Russell Portenoy, chairman of pain medicine and palliative care at
Beth Israel Medical Center in Manhattan, said there was a downside. Some
doctors, he said, prescribed patients tranquilizers that the state did not
track, drugs that had greater potential side effects than those that were
monitored.

When California sought to add certain tranquilizers to its monitoring
program, lobbyists for drug companies and doctors were able to defeat the move.

The drug industry's main trade group, the Pharmaceutical Research and
Manufacturers of America, said it "generally supports" monitoring systems
but said that individual drug companies should decide the issue for themselves.

In recent years drug stores and pain specialists have been the most vocal
opponents of monitoring.

In North Carolina, a drug tracking system was defeated this year, despite
the state's recent problems with OxyContin. That loss frustrated John
Womble, manager of the state's controlled substances regulatory agency, who
had won the support of the state medical society, only to have the bill
opposed by drug stores and some pharmacy chains.

"As long as I'm in state government, we'll continue to try," Mr. Womble said.

In New Mexico last year, the state pharmacy board repealed regulations
needed to operate a tracking system after complaints by pharmacists and
doctors. The New Mexican system had operated for just two years, said Jerry
Montoya, director of the state's pharmacy board.

Pharmacists say they worry about the cost of reporting prescription data.
"How much burden do you want to put on pharmacies?" asked R. Dale Tinker,
executive director of the New Mexico Pharmaceutical Association, which
represents pharmacists.

For its part, Purdue Pharma said it was the only drug company that had
publicly supported monitoring programs. The company has even offered to
help explain the benefits of the systems to physicians.

But Purdue Pharma's support is not unqualified. In West Virginia this year,
Purdue Pharma opposed a bill that would have allowed the state to single
out a number of narcotics like OxyContin for monitoring.

"If you target just one drug, the illegal trade will just move to the next
product that is not watched," said Alan Must, Purdue Pharma's national
director of state governmental affairs.

West Virginia's Legislature quickly passed the bill, but it was vetoed by
Gov. Bob Wise after doctors and pharmacists wrote him letters contending
that the system would violate patients' privacy.

The veto dismayed many people, including William T. Douglass, executive
director of the West Virginia Pharmacy Board. "We have a severe abuse
problem in our state, and we have no way to track it," Mr. Douglass said.

Doctors in some states have begun to support tracking.

Lawrence P. Matheis, executive director of the Nevada State Medical
Association, said physicians had helped design that state's system, which
is often praised by experts as one of the best. By tracking how many
doctors a patient visits, it discourages doctor shopping. So if a patient
goes to 10 doctors for narcotic prescriptions, the state sends letters to
all the doctors.

Keith W. Macdonald, executive secretary of the state's pharmacy board, said
the program did not stop doctors from prescribing narcotics to people who
needed them.

"A person can get three wheelbarrowfuls of drugs and we don't care," Mr.
Macdonald said, "as long as they go to one doctor."

Some states have not started the programs because they believe the costs,
which can reach hundreds of thousands of dollars a year, would exceed the
programs' benefits. But supporters say the systems save taxpayers money in
the long run because of the reduction in fraudulent Medicaid claims and in
the cost of prosecuting drug crimes.

In some states, prosecutors are working on so many cases in which OxyContin
has been obtained illegally through the Medicaid program that they refer to
it as federally financed drug abuse. Medicaid patients can obtain a monthly
supply of OxyContin pills for as little as $1, then sell them on the street
for thousands of dollars.

There is no way to know how many fraudulent prescriptions there might be.
But public officials say that improper OxyContin prescriptions are costing
the public millions of dollars.

Even in Kentucky, a state whose monitoring system is held up as a model,
officials say the huge outbreak of OxyContin abuse there has made them
realize they are going to have to strengthen the program.

Kentucky's program failed to detect early on that OxyContin was becoming a
problem because its staff of three pharmacists were overwhelmed by routine
work, said Danna Droz, a public health department official who oversees the
monitoring effort.

Kentucky is now adding staff members and changing its operations so that it
will better serve as an early warning system, Ms. Droz said. And that will
please Kentucky law enforcement officials like Sheriff Duff, who says
OxyContin remains a problem in Harlan County.

"The supply is decreasing, and it is harder to come by," Sheriff Duff said
of the illegal OxyContin available on the streets. "But it's still coming in."