Efforts to track abuse of pain killers have stepped up in New Jersey, where pharmacies are now helping flag illegal use of pills. By entering the narcotics into a statewide database, pharmacists have expanded their role in the war on prescription drugs.
The database for narcotics like the pain reliever OxyContin went live September 1. It is routinely monitored by physicians, pharmacists, and law enforcers to help identify drug abusers who manipulate the medical system to obtain pills for their own addictions or to sell in the lucrative street drug trade that rivals heroin and cocaine.
Keeping track of the pills is seen as a vital component of halting abuse that begins in medicine cabinets. Dr. Niranjan V. Rao, president of the Medical Society of New Jersey, gave the example of a patient "who shows up in the emergency room in the middle of the night" complaining of pain and requesting painkillers. "You don't know if they are in genuine pain or they are abusing drugs. So you can get online, and you know instantly if it is therapeutic or abuse."
But it's also raised some concerns that pharmacists are increasingly being called upon to function in a law enforcement role that puts them at risk. "You have somebody who is abusing drugs, and they want their drugs, and you risk your life to refuse a prescription," said Sandra Moore, president of the New Jersey Pharmacists Association. "You are dealing with unsteady people."
New Jersey's database is being monitored by investigators with the New Jersey Division of Consumer Affairs, according to its director Thomas Calcagni. "These are seasoned drug diversion investigators, many of whom are pharmacists or nurses. They will be looking for the outliers -- unusual prescribing patterns."
The stakes are high. Deaths from narcotics overdose have more than tripled in the past decade, and 15,000 narcotics users die annually nationwide. "This is the fastest growing drug problem in the country," said Special Agent Brian Crowell of the New Jersey division of the federal Drug Enforcement Administration.
State Attorney General Jeffrey S. Chiesa presented an update on the New Jersey Prescription Monitoring Program on Wednesday at a press conference in Trenton, where he distributed a copy of prescription drug purchases of suspected abuser who used multiple doctors and pharmacies to get 2,500 doses of OxyContin and methadone over 35 days.
Pharmacists who suspect drug abuse can check the database before filling a prescription to see if the customer has been stocking up on pills, Chiesa said. Doctors can check the database to determine if a patient is collecting prescriptions from other doctors. State law enforcement officials are also keeping tabs on the database, which gathers prescribing information on controlled dangerous substances, like OxyContin and Percocet, as well as human growth hormone.
"If they see something that could be a violation of criminal law or the prevailing standards of practice within healthcare, then they will be obligated to refer that case to the appropriate law enforcement agency or the appropriate licensing board," Calcagni said.
Joining the law enforcement agents at the press conference was a New Jersey mother, Meg Dupont-Parisi, whose son Patrick died of a prescription painkiller overdose on November 30 at age 21. He became addicted to OxyContin in high school and spent years in and out of rehab.
"He was a charismatic, intelligent, handsome young man with a bright future ahead of him, until he became addicted to OxyContin," she said.
Drug education of children must begin as early as possible, and parents must lead by example, Dupont-Parisi said. "If you need prescription drugs, keep them locked up. If they are expired, dispose of them. Get them out of your home."
Thomas Bender, vice president of the state board of pharmacy, said 38 states already have a prescription-monitoring program for controlled dangerous substances. For the most part, the state's nearly 7,000 registered pharmacists have been "overwhelming supportive" of the program, he said.
Under state law, pharmacists can refuse to fill a prescription if they suspect it is fraudulent, if they suspect the prescriber was not authorized to write the prescription, or if they believe the drug would harm the patient, Bender said. "So they have to use their common sense, they have to use their professional judgment. That is what they have been relying on up until now. So this [the database] is just another tool in our arsenal to combat drug abuse."
The pharmacist "has to draw on their experience of how to handle the situation," Bender said. "You don't want to be confrontational, you don't want anyone to get hurt. There are a couple of ways you can do this. The best thing to do is just say 'I'm sorry, but I have to verify this prescription with the physician.' Ninety percent of the time they just say 'Oh forget it' and walk out."