State Steps up Efforts to Head off Abuse of Prescription Painkillers

Andrew Kitchenman | March 14, 2014 | Health Care
Requiring doctors to check for abuse patterns appears unlikely as committee chairman opposes mandate

Eric Kanefsky (right), director of the Division of Consumer Affairs
Eight months after a state report detailed the growing abuse of prescription opioids and heroin, the problem has reached epidemic proportions — in both the suburbs and the cities — killing an average of more than one New Jersey resident each day.

State officials are stepping up their efforts to curb this plague, but some of the report’s recommendations, which might help do exactly that, are unlikely to become law.

The July State Commission of Investigation (SCI) report found ties between some physician-led “pill mills” and organized crime. Its recommendation: All doctors in the state be required to participate in the New Jersey Prescription Monitoring Program (PMP).

At an Assembly Health and Senior Services Committee hearing yesterday, state Division of Consumer Affairs Director Eric Kanefsky detailed the severity of the situation and some of the steps the state has taken to reduce the threat posed by opioid abuse.

“By all accounts, prescription drugs abuse is the most serious drug problem that affects New Jersey’s youth,” Kanefsky said.

These steps include making it easier for doctors and advanced practice nurses who prescribe controlled substances to register with the PMP, which includes a database of all dangerous prescriptions dispensed by pharmacies in the state. For example, prescribers will no longer be required to have a document notarized to register with the PMP. Instead, they can register online when they renew their registration to prescribe these drugs.

The state has hired additional investigators with medical experience and initiated 30 legal actions against those with a pattern of indiscriminant prescribing, leading to 14 prescribers having their licenses revoked, Kanefsky said. The state has also added security features to prescription pads that make them more difficult to forge, including using color-changing ink.

While Kanefsky noted that the PMP receives an average of 105,000 data requests from prescribers each month, only 17 percent of eligible prescribers are registered in the program.

Kanefsky said the state is trying to increase participation by holding outreach and education sessions with prescribers.

“We believe the state can do better,” Kanefsky said.

While committee chairman Assemblyman Herb Conaway Jr. (D-Burlington) said he would like to see more doctors participate in New Jersey’s PMP, he opposes a recommendation from the SCI report that they be required to participate.

“The government doesn’t practice medicine – physicians do,” said Conaway, a primary-care doctor.

SCI Executive Director Philip James Degnan noted that the report found some healthcare professionals who were “operating more like street-corner drug dealers than doctors and pharmacists.”

Degnan said “given the way prescription drugs are misused, requiring doctors to participate in the PMP is a “relatively small inconvenience to bear.”

Degnan also said that doctors could benefit from finding out that their patients
sought prescriptions from other doctors, since it could signal in some cases that the patients’ current prescriptions are inadequate to treat their pain.

But Conaway expressed concern that the state would move too far in the direction of denying suffering patients in dire need of pain relief access to medication, by adding requirements on doctors before they prescribe opioids.

Dr. Scott Woska, executive director of the New Jersey Society of Interventional Pain Physicians, reinforced this point.

“If you overburden physicians with complex requirements, then these patients will lose access to proper treatment. You’ll see physicians skirting around the issue of prescribing pain medication altogether and it will not be good for our patients,” Woska said.

Drug Policy Alliance New Jersey Director Roseanne Scotti said eliminating opioid prescription abuse wouldn’t eliminate the drug addiction that drives the abuse, noting research that when OxyContin was reformulated to make it more difficult to abuse, heroin overdoses increased.

“As long as heroin is easier to get in this state than drug treatment, we will not” address the problem, Scotti said.

Assemblyman Joseph Cryan (D-Union) expressed an interest in legislation that would require prescribers to participate, possibly allowing exemptions for emergency physicians who frequently prescribe small amounts of painkillers.

Degnan also noted that the SCI report called for wider law enforcement access to the PMP. Currently local and county authorities can only access data if state officials detect problematic prescription patterns and refer it to local officials, or if local authorities have a subpoena for specific prescribers. The SCI report recommended allowing more law enforcement conducting general investigations to have broader access to the PMP.

Conaway said he opposed more law enforcement access, noting that the issue was debated when the law creating the PMP was passed.

But Conaway agreed with another state recommendation, that doctors be able to designate staff members other than themselves who would be able to access PMP.

The state also is working to allow those who check the PMP to be able to access information from similar databases maintained by other states. This has run into roadblocks with two neighbors. In Pennsylvania, the state has tighter limits on who can access the PMP, which make it difficult for New Jersey prescribers to access the information. New York requires all doctors to access its PMP whenever they prescribe dangerous drugs. This would create too much traffic for the New Jersey PMP, Kanefsky said.

While the hearing was held for the purpose of discussing the issue, the committee took action on a separate measure designed to combat overdoses. It advanced a bill, A-2770, allowing emergency medical technicians to administer naloxone, a heroin overdose antidote. While Scotti felt that a bill signed by Gov. Chris Christie last year already allowed this, regulatory questions had prevented at least some EMTs from using the emergency medication.