Editor’s Note: This article is part of a series produced by the Southwest Times Record in Fort Smith. The entire series will be published online at www.cabotstarherald.com. Next: Addict turns life around.
FORT SMITH — A statewide system tracking the hundreds of controlled substance prescriptions filled in Arkansas is continuing to build its database and is on schedule to go online in early June.
Denise Robertson, director of the Arkansas Prescription Monitoring Program, said months of preparation preceded the program’s legislated start date of March 1. Among activities was contracting with Health Information Design, supplier of the RxSentry system used for the statewide linkup to Arkansas and 16 other states.
The program requires every licensed pharmacist in the state to record filling a prescription to all Schedule II, III, IV and V controlled substances, listing the drug, dosage and amount, as well as the personal identification of the person to whom it was issued. There are some 755 retail pharmacies in the state and more than 150 Internet or mail-order companies filling Arkansas prescriptions, according Jim Myatt, pharmacy branch chief with the Arkansas Department of Health under which the monitoring program operates.
The reports are compiled and sent to the state each week, reporting the transactions of the previous week.
Robertson said in addition to starting the recording process, pharmacists have been charged with providing prescription information for six months prior to March 1. That data is due by May 1.
“When we are able to access the data, we will see nine months of prescription data,” Robertson said.
The data will be made available to pharmacists and physicians, allowing them to track the medications a patient has been prescribed and the physicians who prescribed them. It can thus identify “doctor shoppers,” who secure numerous prescriptions from different sources, and persons attempting to have fraudulent prescriptions filled.
Robertson said law enforcement officers who have obtained a search warrant as well as licensing boards conducting an investigation also can access the system.
She said information is encrypted and secure, with care to protect sensitive patient information. Data requested by researchers or for reporting purposes is “unidentified,” removing anything that would violate the privacy of a particular person.
The Arkansas Legislature created the monitoring program as Act 304 of 2011. No funds were appropriated for the program, which has been funded largely by federal grant funding.
Attempts had been made earlier to establish a program. A federal drug monitoring program was created in 2002, and numerous states have created their own programs in the intervening years. Myatt said the earlier defeat of the initiative led Health Department leadership to assemble a “bridge” group representing 40 or 50 different parties, which arrived at a consensus and developed the legislation that was ultimately adopted.
Myatt estimates the annual operating cost of the program at about $300,000.
Similar monitoring programs are in place in 49 of 50 states, with Missouri being the lone hold-out.
Myatt said the state plans to enhance the system with a link to an interstate database, a move that will prove particularly beneficial in state border towns like Fort Smith, where residents from one state seeking to obtain additional medication secure new prescriptions across the state line to escape detection under that state’s program.
“We’re trying to get grant money for that. We’re hoping to implement it late this year or early next year,” he said.
Robertson said a prime goal of the program is to address a sizable problem of illegal prescription drug abuse.
She said figures from 2008 showed Arkansas second-highest nationally in death by drug overdose. The state ranking continues to be one of the highest. Additional data suggest 13 percent of controlled substances prescribed in the state — many of them opioid pain relievers — are ingested for non-medical use.
Pharmacists Accept Program
While implementation of the program understandably adds a burden to the local pharmacist, Robertson said it has generally been accepted.
“You’ve got to comply with the law,” said Keith Larkin, pharmacist and owner of MediSav Pharmacies in Fort Smith and Charleston. He acknowledged some customers encountering the additional scrutiny may object to what they see as intrusion into their privacy.
“Some are concerned about Big Brother. In this case, Big Brother needs to be watching,” he said.
Larkin said information he received at a recent continuing education program put Arkansas at number 6 or 7 in states with prescription diversion problems.
He said once it is up and running, the state may see a reduction in the numbers of patients coming from Louisiana and Texas to get prescriptions filled.
Larkin likened the program to one introduced to pharmacists several years ago to monitor and limit the sale of products containing ephedrine and pseudo-ephedrine, ingredients often used in the illegal production of methamphetamine.
Justin Boyd, a pharmacist at Coleman Pharmacy in Alma, said the first data-gathering month of the program has not proven a significant burden to his practice.
Boyd pointed out that prescription drug abuse “is a problem in the state and in our area specifically. I believe this (program) will be an important tool to help reverse a devastating trend.”
Paul Smith, a narcotics detective with the Fort Smith Police Department, said the program should provide a look at trends, identify problem areas, reinforce education efforts and reinforce law enforcement efforts.
“Hopefully the data from the program will be a great benefit so that we will be able to better educate problem physicians and go into schools and show them that there is a problem in the community and be able to tailor our approach or attack the problem,” Smith said.
Robertson said most pharmacy customers will not be burdened by the program, or even be aware it exists.
“There’s not been any kickback that we have had to address,” she said.
She said obtaining the needed information is up to the individual pharmacy policies. The PMP does not require a person to show identification to obtain a prescription, Robertson said. Prescriptions are filled “according to controlled substance protocol,” she added.
Reports are currently being submitted once a week. Myatt said reporting periods vary. Oklahoma is working to implement a “real time” reporting system, he said. Several others require daily reports, some others biweekly or even monthly.
“We will work toward daily reporting in the future. Real time is another possibility,” Myatt said.
Times Record reporter Hicham Raache contributed to this report.
The U.S. Code classifies drugs by schedule, based upon their characteristics and uses.
Schedule II substances are those that have a high potential for abuse; have currently accepted medical use in treatment in the U.S., or currently accepted medical use with severe restrictions; abuse of the drug may lead to severe psychological or physical dependence.
Schedule II drugs include:
• Cocaine, used as a topical anesthetic
• Methylphenidate (Ritalin and Concerta) and dexmethylphenidate (Focalin), used in treatment of attention deficit disorder
• Opium and opium tincture (laudanum), used as a potent antidiarrheal
• Methadone, used in treatment of heroin addiction and treatment of extreme chronic pain
• Oxycodone (semi-synthetic opioid; active ingredient in Percocet, OxyContin and Percodan)
• Mixed amphetamine salts under brand name Adderall
• Lisdexamfetamine (Vyvanse)
• Dextroamphetamine (Dexedrine)
• Dextromethamphetamine (Desoxyn)
• Hydromorphone (Dilaudid)
• Pure codeine
• Pure hydrocodone
• Secobarbital (Seconal)
• Pethidine (USAN: Meperidine; Demerol)
• Phencyclidine (PCP)
• Short-acting barbiturates, such as pentobarbital, Nembutal
Schedule III substances are those that have a potential for abuse less than the drugs or other substances in schedules I and II; have a currently accepted medical use in treatment in the U.S.; abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.
Schedule III drugs include:
• Anabolic steroids
• Intermediate-acting barbiturates, such as talbutal or butalbital
• Dihydrocodeine when compounded with other substances, to a certain dosage and concentration
• Ketamine, a drug originally developed as a safer, shorter-acting replacement for PCP but has become popular as a veterinary and pediatric anesthetic
• Xyrem, a preparation of GHB used to treat narcolepsy
• Hydrocodone/codeine, when compounded with an NSAID or acetaminophen, such as Vicoprofen, Vicodin, Tylenol 3
• Marinol, synthetically prepared tetrahydrocannabinol used to treat nausea and vomiting caused by chemotherapy, as well as appetite loss caused by AIDS
• Paregoric, an antidiarrheal and anti-tussive, which contains opium combined with camphor
• Ergine (lysergic acid amide), listed as a sedative but considered by some to be psychedelic
Schedule IV substances are those that have a low potential for abuse relative to the drugs or other substances in schedule III; have a currently accepted medical use in treatment in the U.S.; abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III.
Schedule IV drugs include:
• Benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium)
• temazepam (Restoril)
• flunitrazepam (Rohypnol)
• The benzodiazepine-like z-drugs: zolpidem (Ambien), zopiclone, eszopiclone, and zaleplon
• Long-acting barbiturates such as phenobarbital
• Tramadol (Ultram)
• Carisoprodol (Soma)
Source: Drug Enforcement Administration, Office of Diversion Control