Rx drug abuse a growing problem for doctors, officials
It was a scene close to what Dr. Marc Breen remembered from hospitals in Chicago.
Last December, Breen found himself swamped with new patients over the course of his 12-hour shifts at the emergency room of Community Hospital: three to four people per shift who weren’t dying, but in desperate need of narcotics. The rush came within days of the closure of a local clinic that was being investigated over whether it offered easy and often questionable access to a variety of high-powered, painkilling narcotics.
Urgent Care, a clinic operated by Dr. Sam Jahani and Dr. Eric Peper, or the “candymen” as Breen and others referred to them, had been raided by federal agents before the facility later closed its doors.
“That was the roughest month I’ve had with belligerent patients,” Breen said.
Some had legitimate pain and went to the emergency room after being shunned by primary care doctors, searching for ways to maintain hugely elevated amounts of pain medications they’d become used to, usually with morphine or Oxycontin.
“Medications I would typically prescribe wouldn’t have touched them,” Breen said. “You’re dealing with people you can’t make headway with and there’s no good answer how to help them.”
With increased prescription-drug abuse affecting hospitals and the Mesa County criminal justice system, local officials are plotting how to respond.
As Mesa County prosecutors claim headway in battling methamphetamine over the past three years, reflected in a decline of meth-related felony filings, cases involving prescription drugs represent a steadily growing piece of the local felony caseload.
From January to March, prescriptions drugs accounted for roughly a quarter of Mesa County drug filings, just more than a 10 percent increase measured against the same period dating back to 2007, according to figures from the District Attorney’s Office.
Chief Deputy District Attorney Dan Rubinstein believes law enforcement’s tightened grip on Jahani and Peper played out afterward in a crime spike.
“The habit hasn’t gone away, but people are no longer able to get to the scripts they were depending on,” Rubinstein said.
Rubinstein and others believe the two doctors, who remain under investigation by the Drug Enforcement Administration, are the exception among western Colorado physicians who largely are responsible in distribution of prescription drugs.
A subcommittee of Colorado’s Meth Task Force is in the early stages of crafting legislation intended on cracking down on doctor shopping, the practice of obtaining multiple, overlapping prescriptions for the same drug in a short period of time.
Rubinstein, who chairs a prescription drug working group of the task force, is knee-deep in a proposal that would overhaul Colorado’s online Prescription Monitoring Database, which went live in July 2007. The database was aimed at giving professionals another tool to flag doctor shopping, with information including patients’ names and medications prescribed, as well as when and where they were filled. Colorado pharmacies are required by law to report the dispensing of controlled narcotics to the system.
The database is flawed because pharmacies are required to send data only bimonthly, leaving people plenty of time to scam the system.
Rubinstein said the proposal would mandate data entry at the time of filling a prescription, while a “hold” would be placed on the request if an overlapping prescription for the same medication exists.
The doctor who issued the earlier prescription would have to give his or her approval for overriding the flag before filling the new request.
“This operates under the assumption doctors and pharmacists provide good patient care if given complete and accurate information on a patient’s situation,” Rubinstein said.
Delays for all
Cost, and the logistics, of wiring all Colorado pharmacies with real-time technology remains among the proposal’s biggest obstacles.
“I wonder how many physicians are routinely checking (the existing database) right now?” Breen asked, noting Grand Valley doctors also have access to another database, the Quality Health Network, which includes information on a patient’s emergency room visits and physician care notes.
Delays for customers, pharmacists and doctors are also concerns.
“Most of my time is often forced into more paperwork than patient care,” Breen said of insurance, regulatory, legal and billing demands. “More regulation just takes me farther away from my patients.”
A national narcotic and prescription database, accessible by any licensed health professional, would reach across state lines but would present its own potential pitfalls, the doctor said.
“I routinely see the 90-year-old patient who ‘forgot her meds at home’ and can’t remember a single med,” Breen said, while also raising concerns about patient privacy in such a system.
“What if an insurance company found that you were on Prozac 10 years ago, and now doesn’t want to cover mental health issues under some vague pre-existing conditions clause?” he asked.