49 States Combat Opioid Epidemic With Prescription Database
DAVID GREENE, HOST:
The opioid addiction, the drug epidemic facing the country right now, is getting worse. And we're going to spend some time this morning looking at one possible way to combat it. We're joined by Danna Droz from the National Association of Boards of Pharmacy. She's a pharmacist herself and an attorney who has worked on efforts in Kentucky and Ohio to track who is getting opioids illegally. Danna, good morning.
DANNA DROZ: Good morning.
GREENE: Can you just start by reminding us how bad this epidemic has gotten?
DROZ: Well, this has continued to get worse over the last several years. But we're starting to see a few signs that it might be getting better, at least on the prescription drug side. But it's still a huge problem. And we still have a lot of work to do.
GREENE: Now, you say getting better on the prescription drug side. Tell me what you mean by that. And then tell me what other ways are out there that people are getting their hands on these drugs.
DROZ: Well, we've got a heroin problem that has risen dramatically in the last few years. And we see a lot of people that start on prescription drugs and for one reason or another move to heroin in addition to those that might start out on heroin.
GREENE: Well, stay with me. I actually want to play a piece for you if I can. It's a story that comes to us from Bram Sable-Smith, who's a reporter at KBIA in Missouri. It's focusing on the prescription drug side of what we're talking about. And he met a pharmacist named Richard Logan in the town of Charleston, Mo.
BRAM SABLE-SMITH, BYLINE: In addition to his day job, Richard Logan is also a sheriff. And if he doesn't just arrest a pill seeker on the spot, he'll direct them out of town with a firm warning.
RICHARD LOGAN: They need to tell their friends not to stop here because if they do, the next one I see I'm going to arrest. And I'm going to arrest whoever's with them. And I'm going to impound their car. And I'm going to search their car.
SABLE-SMITH: As a sheriff, Logan can do a lot. But as a Missouri pharmacist, one thing he can't do is check a database to see if someone is trying to illegally get opioids. That's a tool pharmacists have in the 49 other states with something called the prescription drug monitoring database. These allow physicians and pharmacists to review a person's history with prescription narcotics to look for signs of abuse. Without a database, keeping that history hidden is as easy as paying cash. And that's turned Missouri's pharmacies into targets.
HOLLY REHDER: Where I'm from, you know, which is right in the corner of the state, we have people coming in from other states just to get their narcotics here.
SABLE-SMITH: The opioid crisis is very real to state Representative Holly Rehder. Many members of her family have battled opioid addiction, including her own daughter. And since she was elected in 2012, she's become prescription drug monitoring's champion in the state. But effective prescription drug monitoring requires comprehensive data collection. And that's a problem for one of her fellow Republican lawmakers, Senator Rob Schaaf.
ROB SCHAAF: The monitoring program would put every citizen's private drug information on a government database accessible to 30,000 people with usernames and passwords. And that's just an outrage.
SABLE-SMITH: Schaaf lead a successful 8-hour filibuster of prescription drug monitoring legislation the year before Rehder took office. That has loomed over her attempts to pass a bill. She says the database would be bound by the same privacy laws that already protect existing electronic medical records.
REHDER: It's not like anyone from the state can go on a fishing expedition in this data.
SABLE-SMITH: But Schaaf says he's also worried about hackers.
SCHAAF: There is no data that's secure. Look at all of the hackings that have been done, the IRS, the VA.
SABLE-SMITH: Rehder counters that Missouri can learn from the other states that have done this already. But lawmakers only have until Friday to pass a bill this year, and they probably won't find common ground by then. For pharmacists like Richard Logan, that gridlock has gone on for too long.
LOGAN: Other states are doing everything they can do to address that. Missouri is doing nothing, nothing. That's very frustrating. To my mind, it's criminal.
SABLE-SMITH: So he'll keep taking the law into his own hands. For NPR News, I'm Bram Sable-Smith in Missouri.
GREENE: OK. We were listening to that piece there with Danna Droz from the National Association of Boards of Pharmacy. And Danna, these databases that we're hearing about there that this pharmacist in Missouri so desperately wants, what is it? How does it actually work?
DROZ: Well, each state has to pass a law that requires pharmacies and potentially other dispensers to report to a state database any prescriptions for abusable drugs - it's not all drugs, just abusable drugs - on a frequency defined by the state law. So all the pharmacies in the country are reporting to their state database except in Missouri.
GREENE: Let me ask you. You're describing that pharmacists, you know, take part in this reporting. What happens with that information? I mean, are doctors in all of these states required to look up and see if someone's on a database before they prescribe an opioid? Or how does that work?
DROZ: The programs all started out as voluntary. Some states have passed mandatory use requirements that do require prescribers and pharmacists to look up patients before prescribing or dispensing. That is a trend among states right now to pass mandatory access laws. So there's some anecdotal evidence that that's extremely effective. Doctors are finding patients that need closer monitoring or maybe referrals to treatment that they didn't realize had a prescription drug abuse problem or potential problem.
GREENE: It sounds like one of the real keys here is to put requirements in place that doctors are actually checking these kinds of databases before they prescribe. Is that fair?
SABLE-SMITH: That's a fair statement based on what we're seeing. However, like most people, doctors are a little resistant to mandates that they do something that they're not currently doing. What we'd really like to see is make the information more readily available to doctors. If it were available with what I call one-click access, where all they have to do is click an icon and they can see it, I think that would be the best of all possible worlds.
GREENE: Danna, step back for me if you can, and talk to me about the concerns raised by a lawmaker in that piece we heard about privacy. I mean, that is, as much as you try and protect databases like this, you know, a government database can always be hacked. And someone's privacy could really be compromised.
DROZ: Well, that's true. There's - with any database, that's a potential risk. However, these databases have been in existence for, well, the first one was California in 1939. Obviously, that was not computerized. But since the mid-'90s, they're all very computerized. They're all built with security in mind, protection. And there's not been a hack of these databases yet.
GREENE: Danna Droz, thanks very much for talking to us.
DROZ: You're welcome. It's been a pleasure, thank you.
GREENE: That was Danna Droz from the National Association of Boards of Pharmacy. What you just heard is part of a reporting partnership with NPR, Side Effects Public Media and Kaiser Health News.
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