Gazette opinion: Too many pills; Montana must stop painkiller abuse

2013-06-16T00:10:00Z 2013-07-25T09:15:04Z Gazette opinion: Too many pills; Montana must stop painkiller abuse The Billings Gazette
June 16, 2013 12:10 am

Last month, 240,000 prescriptions for painkillers were added to the confidential statewide prescription drug registry.

In a state with barely 1 million people, that’s a lot of OxyContin, Oxicodone, Diluadid, Demerol, morphine and other opioids. And that’s just one month.

The 2011 Legislature created the statewide prescription drug registry as a tool for doctors and pharmacists to be better informed about their patients so they can deliver optimal care. The registry was designed to curb doctor shopping for narcotic prescriptions.

The registry started running last year, so its full impact isn’t yet known. All Montana pharmacies are required to report controlled substance prescriptions to the registry. That includes mail order pharmacies shipping to Montana patients. The 700 pharmacies reporting to the Montana registry include Indian Health Service pharmacies, and soon the VA will participate.

17% participation

However, under the law, participation is voluntary for prescribers. So far, less than 17 percent of eligible providers are participating, according to the Montana Board of Pharmacy.

As one of the last states to set up a statewide prescription drug registry, Montana is playing catch-up. We must do much more:

- All prescription-writing professionals should be encouraged to use the registry to assure the best patient care.

- Health care providers need more training on appropriate use of painkillers.

- All Montanans need to understand the problems of prescription drug abuse.

Marcie Bough, executive director of the Montana Board of Pharmacy in Helena, said many providers have reported modifying their patient’s treatment plan based on information in the registry. Some providers have been able to identify forged prescriptions based on their review of registry information.

Bough said the Board of Pharmacy is working on improvements to the program, including increasing awareness of the registry, providing the ability for providers to delegate authority to staff members to search the registry on their behalf, and sharing registry information across state lines.

In the past year, the Montana Division of Criminal Investigation has seen more instances of doctor shopping and prescription forgeries, according to John Barnes, Justice Department spokesman. However, agents believe the increase may be due to the prescription drug registry bringing these problems to light and making them easier to detect.

It’s gratifying to know that Billings’ largest health care organizations — Billings Clinc, St. Vincent Healthcare and RiverStone Health are participating in the registry — and collaborating to improve patient care.

Physicians and other prescribing providers employed by St. Vincent Healthcare “make heavy use” of the registry, according to Dr. Mike Bush, chief medical officer. “It’s very helpful.”

“The registry program allows our doctors, pharmacists and other providers to easily identify patients who may be abusing controlled substances and to identify patients that may be seeking prescriptions for those controlled substances from several physicians,” said Aimee Hillis, manager of outpatient pharmacy services at Billings Clinic.

“The physician is then able to evaluate and adjust the treatment plan to offer the best possible care for all patients.”

At RiverStone Health, education on appropriate use of prescription painkillers is designed to benefit patients and also to train new doctors in the Montana Family Medicine Residency. As RiverStone worked to reduce use of opioids, many patients went elsewhere to get those drugs, said Dr. Megan Littlefield, medical director.

A community-wide approach is essential, Littlefield said. RiverStone, St. Vincent, Billings Clinic and Rimrock Foundation have formed a pain management committee to work on protocols that can be used throughout the community.

“Chronic pain is challenging for patients,” Littlefield said. “It requires a multidisciplinary approach. Exercise and lifestyle changes are 90 percent of chronic pain management.”

Prescription painkillers have a valuable role in managing acute and chronic pain, she said. But a high percentage of painkiller abusers started out as pain patients.

“Prescription drug abuse is the largest growing drug problem in the United States,” Littlefield said.

Montana fatalities

According to a recent report in the Annals of Internal Medicine, more Americans died last year of prescription drug overdoses than died in motor vehicle crashes.

That statistic holds true in Montana where the Department of Justice reports that 300 deaths in 2008 were due to prescription painkillers. Fewer than 300 people died in highway crashes that year.

“This really is something we need to educate that public and providers about,” Littlefield said.

The 2013 Legislature called for a study of prescription drug abuse. The SJ20 study was assigned to the Children and Families Interim Committee. We join Billings health care organizations in calling on lawmakers to give this assignment high priority.

The committee should research prescription drug abuse and draft legislation that improves the statewide registry, enlists the help of health care providers, enhances law enforcement efforts and significantly raises public awareness that too many pills are killing Montanans.

Copyright 2014 The Billings Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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