Targeting Tennessee’s Drug Utilization Rates
New Program Focuses on Schedule II Narcotics
Targeting Tennessee’s Drug Utilization RatesNew Program Focuses on Schedule II Narcotics
The Tennessee Medical Association (TMA), in partnership with several other state organizations and agencies, recently launched the Tennessee Prescription Safety Program to target misuse and abuse of schedule II narcotics.

The new program is an initiative of the Tennessee Foundation for Quality Patient Care, a non-profit organization formed by the TMA to specifically look at the state’s prescription drug utilization patterns and come up with viable solutions where overuse is found.

“It’s unfortunate, but Tennessee has a serious drug problem,” Dr. Robert Kirkpatrick, foundation chair and president-elect of the TMA, said at the program launch.

With the highest per capita prescription drug utilizations rates in the nation, this cooperative initiative is seen as a first step in bringing together prescribers and dispensers to really examine prescribing patterns and uncover fraudulent activity with the aid of technology. Members of the TMA, Tennessee Pharmacists Association (TPA), Tennessee Department of Health and Tennessee Bureau of Investigation (TBI) have joined forces to oversee and implement the program.

“For years, Tennessee has been an outlier among states for our extraordinarily high use of prescription drugs and particularly schedule II prescription narcotics,” noted Russ Miller, senior vice president of the TMA. “Those statistics have brought some concerning remarks and accusations towards physicians in general.”

For that reason, TMA embarked on research to examine the state’s culture for using schedule II narcotics and found that prescription drug abuse is predicted to soon overtake illicit drug abuse in Tennessee.

“While sometimes it’s hard to admit you are part of the problem, it would be foolish for an organization of doctors to turn their backs and not admit they have some role in misprescribing,” Miller said. “Rather than gloss over the problem, our organization decided to meet it head on and to develop the solution.”

The underlying reasons for Tennessee’s prescription drug problem are multifactorial ––from broad healthcare coverage providing widespread access to medications … to being home to an older, unhealthier population … to having physicians who need updating in prescription management protocols. Furthermore, business opportunities clearly exist for the unscrupulous. Miller pointed out that a hydrocodone pill that costs approximately 80 cents to prescribe has a street value of around $8 to $10.

Interestingly, he continued, agents with the TBI have said that if you look at the currently known abuse patterns in the state, they resemble those of the old bootlegging routes … so a culture for illicit activity is long established in Tennessee.

To combat these problems, TMA and TPA are working hand-in-hand.

“We’re happy to have the opportunity to partner with our friends in medicine,” said Baeteena M. Black, DPh, executive director of the TPA. “The more sharing and working together we do, the better patients are served.”

Black added that by bringing each organization’s expertise and resources to the table, the group was able to craft a program that should be both effective and informative.

“The state of Tennessee enacted legislation in 2002 to develop and implement a controlled substance database,” she said. “This past December, that database was made operational.”

Now most dispensers, primarily pharmacists, report prescription fulfillments twice a month. Black noted there are certain exemptions, such as the dispensing of a controlled substance in an emergency room, hospital inpatient setting or nurs
ing home where a healthcare professional is administering the drug.
Black said in talking with colleagues in other states who have implemented similar databanks, she has been told that it is both easy and apparent to spot patterns. Furthermore, she said, abuses decrease noticeably once everyone realizes the information is captured and traceable.

At the heart of the new Tennessee Prescription Safety Program is swipe card technology much like a bankcard utilizes. In the pilot program, Miller explained, a prescriber will electronically enter information regarding the schedule II narcotic including drug name, dosage and length of usage. Then, before a patient leaves the physician’s office, their participating health card will be swiped and uploaded with the prescription information.

At that point, prescribers will be given a “yes” or “no” in real time as to whether or not another schedule II narcotic prescription is active on the patient’s card. This should help eliminate “doctor shopping.”

When the paper prescription and card is then taken to the pharmacy, the fulfillment information is entered into the system. Although someone set on abusing the system might forge copies of a prescription and take it to multiple pharmacies in a quick timeframe, the technology should throw up red flag and at least initiate a dialogue between the prescriber and dispenser. Miller said that even if someone slips through the cracks in the short-term, the new Pharmacy Board fulfillment databank should capture the abuse pattern.

“This is an intermediate step to give dispensers and prescription writers immediate information, but the big picture is that eventually we’re going to expose the cheaters,” Miller said.

Black noted the partners are well aware there is a fine line that must be walked to make sure patients receive the care they need.

“Our primary concern is always that patients who need treatment … that are in pain and suffering … have access to the medications they need,” she said. “But,” she continued, “we have to balance that with the reality that some individuals are out seeking drugs.”

The second component to the Tennessee Prescription Safety Program is to better educate physicians and other prescribers.

“There’s 30,000 people who can prescribe in Tennessee … 30,000 people with the power of the pen,” said Miller.

Black added, “We all agree we need to have all healthcare providers that are involved in the prescribing, dispensing and utilization of schedule II narcotics be brought up to date. Let’s make sure everyone has the best information.”

To that end, regional and online seminars on proper prescribing practices will be conducted in partnership with Nashville-based HealthStream, a healthcare research and educational solutions company.

“Let’s be better educated,” Miller concluded. “We don’t want anyone to go without a needed prescription, but we want all prescriptions to be proper.”

The Tennessee Prescription Safety Program has been made possible by a two-year, $460,000 grant from the Physicians Foundation for Health System Excellence. The foundation’s funding is derived from national settlement dollars from the recent lawsuits between physicians and health plans such as Aetna and Cigna.

July 2007