A recent meeting with the State Substance Abuse Task Force brought to mind a paper I wrote this past summer. According to a Forbes magazine report by Rebecca Ruiz, in 2009, West Virginia “filled 17.7 prescriptions per capita compared to a national average of 11.5.”
There are many factors contributing to these numbers; however, one stands well apart from the others. Like most of the South, southern West Virginia is rife with prescription drug abuse. Due to a lack of a viable system to track written prescriptions, dealers, addicts, and some providers take advantage of system in need of a serious overhaul.
In 2004, the Drug Enforcement Administration instituted an optional electronic prescription program which afforded medical and pharmaceutical practitioners a system that eliminated the need for paper requests and provided a means to track how many prescriptions each patient was receiving at a given time. Unfortunately, an optional system is treated just so — as optional.
There is a glaring need for this system to become mandatory not only to save lives, but improve the efficiency of our health care system and decrease the criminal element on our streets.
Addiction to and trafficking of prescription drugs has become such a problem in places like Mercer County, local communities are being included in the Appalachia High Intensity Drug Trafficking Area (HIDTA), which allots federal funding to assist in the interdiction of illicit prescription drugs. This funding will provide more “boots on the ground” that will increase law enforcement presence in high-traffic areas.
This is a positive step, but it’s one that can be taken further by interdicting at the source: the health care system. Doctor shopping is a method in which addicts and dealers go to multiple outlets such as doctors’ offices, pain clinics and emergency rooms with complaints of pain or mental distress, hoping to find a sympathetic ear and a willing individual with a prescription pad.
Madison Park, of CNN, recently reported “Doctor shoppers often visit facilities where medical professionals don’t know them,” which allows the “shoppers” to visit numerous facilities, sometimes with a different identity. An electronic system would effectively “have the potential to reduce prescription forgery,” according to the Drug Enforcement Administration.
Stacey Hicks, CEO of Princeton Rescue Squad, Inc., relates the use of the anti-opiate Narcon has increased six-fold in his area of responsibility over the last six years, a statistic that highlights the abuse in one rural county by itself. These are factors that can effectively be reduced through the checks-and-balances of a computer based prescription issue system. With this system, legitimate patients in need of care can have access to their providers in a much timelier manner.
Critics could argue such a system would be difficult to fund. The above-cited DEA report estimated a cost of $35 million per annum, per state, to implement and operate the database. Considering the 55 counties of West Virginia received more than $190 million back from the court system in 2009, the amount needed is available and a proverbial “drop in the bucket.”
Others in the opposition cite poor health habits as a major problem in prescription abuse. According to Forbes, Dr. Jane Barlow, vice president of medical strategy and clinical quality for Medco Health Solutions, states the “rates of heart disease, obesity and diabetes are higher than the national average, particularly in West Virginia,” which points to a need for more effective lifestyle education for the general populace.
With the projected increased efficiency of the health care system, individuals who fall into these groups would have better access to education and treatment, thus decreasing the need for a litany of medications and reducing the demand for drugs in West Virginia.
Drug manufacturers are often perceived as potential critics for this proposal however, a recent conversation with a sales representative elicited evidence that the companies themselves are altering the compound of an opiate in order to change the effects of the drug if taken by any other method besides oral.
Medical institutions reluctant to participate in this program are ignoring the opportunity to prevent possible drug interactions and affording a reduction of the backlog within the appointment system by taking part in “E-prescribing” as it is referred to by CBS Detroit. The opposition’s argument over reasons not to participate are as thin as a playing card when compared to the stated benefits of such a program. The only major obstacle is certification. Apparently, the system that is in place requires at least three certifications before it can become the norm.
Our leadership needs to streamline and fast-track this process in order to tackle this problem head-on. One health professional stated E-scripts could become a reality within two weeks of certification. Granted, E-prescribing cannot eradicate the criminal element, but it can force the criminals to obtain drugs through higher-risk methods that can lead to stiffer punitive penalties.
Given Mercer County’s designation as a High Intensity Drug Trafficking Area, it is imperative more needs to be done in order to better control the methods of obtaining prescription drugs. The abuses have become such that the issue has been described as a “plague” by state leadership. This plague directly affects the health system by causing a back-log of appointments and prolonged waits for patients with real medical problems.
For a state that is at the forefront of major health issues (i.e. heart disease and diabetes), it is apparent more accessible care is imperative. Other benefits of E-prescriptions are job creation and a system of accountability. Databases, servers, and ancillary equipment will need servicing and upgrades.
Clearly, the need for electronic prescriptions would be a useful tool in the dispensation of medication by nullifying a source for the illegal dealers of pills, increasing the efficiency of the health care system, informing providers of the patient’s history and needs, creating viable employment in economically depressed regions, and assisting in the health education of the general public. The funding exists, and the need is apparent. It is time for our lawmakers to stand up and change “optional” to “mandatory.” Otherwise, the mantle of “best of the worst” will remain synony