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Controlling controlled substances (part one): Tennessee efforts against drug diversion

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Your Intrepid Pharmacist hates the word “crisis.” Everything now is a crisis. The Oil Spill Crisis. The Afghan Crisis. The Methamphetamine Crisis. The Economic Crisis. The Famous-celebrity’s-name-here Crisis. Even a bad hair day now feels like a crisis. The mainstream press has drained the word of virtually any meaning since every new problem to appear is instantly branded “the fill-in-the-blank crisis,” as if the whole world really needs a collective dose of Xanax (alprazolam) to mellow its anxieties, or an Oxycontin (extended release oxycodone) to ease its pain. Of course, the possibility exists that such efforts form the basis for what only can be another crisis. You can decide that as you read and watch your way through this two-part column.

A huge narcotics problem has emerged in Tennessee, but whose origins are from outside the state. Here is how it happened…

Several years ago, in the wake of narcotics problems within the state, the legislature took several important actions. First, they criminalized doctor shopping, the fine art of having multiple physicians unknowingly prescribing a patient the same drugs simultaneously, which the patient then filled at multiple pharmacies. Medicaid patients caught doctor shopping would forfeit their Medicaid (e.g. TennCare) coverage.

Second, Tennessee followed the actions of several other states, including Kentucky, in creating a controlled substance monitoring database. This database contains reports that can be accessed by health care professionals (i.e. physicians and pharmacists). Any place a patient fills a medication—even if it is for cash—shows up on the report, detailing prescriber, drug, quantity, days supply and location filled. Your Intrepid Pharmacist has found a number of patients over the last few years that were playing the doctor shopping game. Some for Ambien, some for Lortab, some for Xanax. Some were trying for the harder drugs like oxycodone (brand names Roxicodone and Oxycontin).

Third, the legislature required the use of tamper proof prescription pads for all prescriptions written in Tennessee. The number of forged prescriptions dropped like a stone, though theft and attempted theft of prescription pads went up. Happily, such thefts are easily reported through the controlled substance database and the Tennessee Pharmacists Association, so medical professionals are on the lookout for any suspicious prescriptions. Also increasing are drug robberies, both large—arrests for robbing area pharmacies of narcotics (one case here and video below—and small—such as this article on a Chattanooga pharmacy technician who was stealing hydrocodone for her school teacher husband to sell.

 

For the legislature’s efforts, though, Tennessee was rewarded with a drop from first place in the nation for number of prescriptions per person; West Virginia took over the top spot. Tennessee also jumped from 48th in the National Health rankings to 44th.

But all is not as it seems. And this positive direction may not last long. Enter Florida.

Florida does not have a monitoring system for controlled substances. The state has no monitoring system for much of anything in the realm of prescription narcotics. The result is a proliferation of pain clinics. Not legitimate pain management offices that cancer patients and severely injured patients visit, as are found in Tennessee, but pain clinics that will write for huge amounts of narcotics. All visits and prescriptions are done on a cash only basis—no insurance is accepted. In Broward County (where Fort Lauderdale is), pain clinics almost rival McDonald’s for location counts.

Some readers may be thinking about now, “What do pain clinics in Florida have to do with Tennessee?” Part Two of this column will examine how Florida is feeding the drug habits of Tennessee...and the high probability the word crisis will be involved.
 

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